Provider Demographics
NPI:1184855868
Name:GRABER, DEREK O (DDS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:O
Last Name:GRABER
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 1:400 E DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-3714
Mailing Address - Country:US
Mailing Address - Phone:812-461-2365
Mailing Address - Fax:
Practice Address - Street 1:400 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-3714
Practice Address - Country:US
Practice Address - Phone:812-461-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011289A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice