Provider Demographics
NPI:1497889877
Name:GRAFF, JAMES J (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:GRAFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 AVENUE D STE 101
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1955
Mailing Address - Country:US
Mailing Address - Phone:308-537-3359
Mailing Address - Fax:308-537-3368
Practice Address - Street 1:902 AVENUE D STE 101
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1955
Practice Address - Country:US
Practice Address - Phone:308-537-3359
Practice Address - Fax:308-537-3368
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6042OtherLICENSE #