Provider Demographics
NPI:1760482046
Name:GRAVES, SHELDON MAURICE
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:MAURICE
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 KIRBY PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115
Mailing Address - Country:US
Mailing Address - Phone:901-433-0701
Mailing Address - Fax:901-433-0703
Practice Address - Street 1:4137 KIRBY PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-6532
Practice Address - Country:US
Practice Address - Phone:901-433-0701
Practice Address - Fax:901-433-0703
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TNDS00000044171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry