Provider Demographics
NPI:1295188761
Name:GRAVES, CARL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:STEPHEN
Last Name:GRAVES
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 1:2631 HIDDEN CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9467
Mailing Address - Country:US
Mailing Address - Phone:850-712-2307
Mailing Address - Fax:
Practice Address - Street 1:300 HOLLYWOOD BLVD SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5727
Practice Address - Country:US
Practice Address - Phone:850-243-4723
Practice Address - Fax:850-243-0184
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist