Provider Demographics
NPI:1083186126
Name:CYNTHIA GRAVES DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:CYNTHIA GRAVES DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-258-8001
Mailing Address - Street 1:10418 LAKE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1226
Mailing Address - Country:US
Mailing Address - Phone:512-258-8001
Mailing Address - Fax:512-258-4106
Practice Address - Street 1:10418 LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1226
Practice Address - Country:US
Practice Address - Phone:512-258-8001
Practice Address - Fax:512-258-4106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYNTHIA L GRAVES DDS LLP., LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental