Provider Demographics
NPI:1295824241
Name:J. KEVIN MCGRAW D.D.S., P.C.
Entity Type:Organization
Organization Name:J. KEVIN MCGRAW D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-441-4415
Mailing Address - Street 1:309 CENTRE POINTE DR.
Mailing Address - Street 2:STE 200
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-4415
Mailing Address - Fax:636-441-1704
Practice Address - Street 1:309 CENTRE POINTE DR.
Practice Address - Street 2:STE 200
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-441-4415
Practice Address - Fax:636-441-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO135421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty