Provider Demographics
NPI:1568539526
Name:GRAFF, TERRENCE L (DDS)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:L
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 1:10741 W. 165TH ST.
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-364-1155
Mailing Address - Fax:708-364-2010
Practice Address - Street 1:10741 W. 165TH ST.
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-364-1155
Practice Address - Fax:708-364-2010
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190145681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
363140815Medicare UPIN