Provider Demographics
NPI:1346427416
Name:CHARLES E GRAPER MD DDS PA
Entity Type:Organization
Organization Name:CHARLES E GRAPER MD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-6661
Mailing Address - Street 1:832 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6415
Mailing Address - Country:US
Mailing Address - Phone:352-331-6661
Mailing Address - Fax:352-331-6336
Practice Address - Street 1:832 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6415
Practice Address - Country:US
Practice Address - Phone:352-331-6661
Practice Address - Fax:352-331-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00451001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH678Medicare PIN