Provider Demographics
NPI:1760871131
Name:BARRY R. DEGRAFF, D.D.S.
Entity Type:Organization
Organization Name:BARRY R. DEGRAFF, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DEGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-923-9707
Mailing Address - Street 1:315 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5509
Mailing Address - Country:US
Mailing Address - Phone:386-734-2320
Mailing Address - Fax:386-734-8955
Practice Address - Street 1:315 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5509
Practice Address - Country:US
Practice Address - Phone:386-734-2320
Practice Address - Fax:386-734-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty