Provider Demographics
NPI:1568686905
Name:GRAVES, WILLIAM EDWARD II (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GRAVES
Suffix:II
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 1:5051 S SONCY RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6667
Mailing Address - Country:US
Mailing Address - Phone:806-353-1055
Mailing Address - Fax:806-353-7077
Practice Address - Street 1:5051 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-353-1055
Practice Address - Fax:806-353-7077
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82581223S0112X
TX236781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200240630AMedicaid
TX209295901Medicaid