Provider Demographics
NPI:1376036699
Name:JENNINGS, SETH GRAFF (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:GRAFF
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8394 LOWER TRAILHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6150
Mailing Address - Country:US
Mailing Address - Phone:928-201-3221
Mailing Address - Fax:
Practice Address - Street 1:1093 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5904
Practice Address - Country:US
Practice Address - Phone:928-758-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist