Provider Demographics
NPI:1245616622
Name:GRAVES, MORRIS RUSSELL III (DMD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:RUSSELL
Last Name:GRAVES
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:MORRIE
Other - Middle Name:RUSSELL
Other - Last Name:GRAVES
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9411 ALAMEDA AVE
Mailing Address - Street 2:STE P
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-5640
Mailing Address - Country:US
Mailing Address - Phone:915-858-6868
Mailing Address - Fax:
Practice Address - Street 1:9411 ALAMEDA AVE
Practice Address - Street 2:STE P
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-5640
Practice Address - Country:US
Practice Address - Phone:915-858-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice