Provider Demographics
NPI:1598800112
Name:GRAFF, THEODORE W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:W
Last Name:GRAFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4 JEREMYSQUAM WAY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04578-3356
Mailing Address - Country:US
Mailing Address - Phone:207-882-9863
Mailing Address - Fax:207-882-9042
Practice Address - Street 1:171 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1531
Practice Address - Country:US
Practice Address - Phone:207-443-9721
Practice Address - Fax:207-443-9722
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics