Provider Demographics
NPI:1598193088
Name:DEREK GRAFF DMD LTD
Entity Type:Organization
Organization Name:DEREK GRAFF DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-327-4884
Mailing Address - Street 1:3180 N BUTLER AVE
Mailing Address - Street 2:BLDG 200
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2334
Mailing Address - Country:US
Mailing Address - Phone:505-327-4884
Mailing Address - Fax:
Practice Address - Street 1:3180 N BUTLER AVE
Practice Address - Street 2:BLDG 200
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2334
Practice Address - Country:US
Practice Address - Phone:505-327-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental