Provider Demographics
NPI:1588680334
Name:GRAVES, KENNETH MURDOCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MURDOCK
Last Name:GRAVES
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 1:23608 RIM RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7236
Mailing Address - Country:US
Mailing Address - Phone:360-893-6154
Mailing Address - Fax:
Practice Address - Street 1:A-112-DENT AMERICAN LAKE VAMC DENTAL CLINIC
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-589-4005
Practice Address - Fax:253-589-4162
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist