Organization
DE GRAFFENRIED DENTAL, PLLC
Active
Other names
J de Graffenried Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER SAMPLES (HUMAN RESOURCES)
(903) 984-0614
Entity
Organization
Contact information
Practice address
238 LAWRENCE ST, KILGORE, TX 75662-2610
(903) 984-0614
(903) 984-3834
Mailing address
238 LAWRENCE ST, KILGORE, TX 75662-2610
(903) 984-0614
(903) 984-3834
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437762622
NPI
TX
01
—
1831205004
NPI
TX
Enumeration date
01/22/2021
Last updated
01/22/2021
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