Provider Demographics
NPI:1033379581
Name:GRAUE, JOHN REESE II (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REESE
Last Name:GRAUE
Suffix:II
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 1:1914 WHITE TAIL LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2589
Mailing Address - Country:US
Mailing Address - Phone:816-809-6154
Mailing Address - Fax:
Practice Address - Street 1:6301 N OAK TRFY STE 202
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-4752
Practice Address - Country:US
Practice Address - Phone:816-452-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080141511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice