Provider Demographics
NPI:1003952003
Name:GRAVES, STUART LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LEE
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1631
Mailing Address - Country:US
Mailing Address - Phone:703-425-5010
Mailing Address - Fax:703-323-7287
Practice Address - Street 1:5206 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1631
Practice Address - Country:US
Practice Address - Phone:703-425-5010
Practice Address - Fax:703-323-7287
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
347288OtherUNITED CONCORDIA
DC64390001OtherCAREFIRST BCBS
VA209216OtherANTHEM BCBS