Provider Demographics
NPI:1467466474
Name:C, GRAF CORNISH DDS PC
Entity Type:Organization
Organization Name:C, GRAF CORNISH DDS PC
Other - Org Name:DISTINTIVELY DESIGNED SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:GRAF
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-688-3398
Mailing Address - Street 1:1189 S PERRY ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1958
Mailing Address - Country:US
Mailing Address - Phone:303-688-6698
Mailing Address - Fax:303-688-3846
Practice Address - Street 1:1189 S PERRY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1958
Practice Address - Country:US
Practice Address - Phone:303-688-6698
Practice Address - Fax:303-688-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty