Provider Demographics
NPI:1033594700
Name:GRAVES, NATHAN (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 N 940 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7704
Mailing Address - Country:US
Mailing Address - Phone:801-318-6994
Mailing Address - Fax:435-657-1707
Practice Address - Street 1:949 N 940 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7704
Practice Address - Country:US
Practice Address - Phone:801-318-6994
Practice Address - Fax:435-657-1707
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9396502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist