Provider Demographics
NPI:1356662829
Name:GRAVES, LINDSEY NICHOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:NICHOLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:866-273-8204
Mailing Address - Fax:866-803-4943
Practice Address - Street 1:1116 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2370
Practice Address - Country:US
Practice Address - Phone:812-283-1100
Practice Address - Fax:812-283-4177
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011482A1223G0001X
KY9128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice