Provider Demographics
NPI:1922157825
Name:GRAVES, CYNTHIA LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 LAKE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1226
Mailing Address - Country:US
Mailing Address - Phone:512-258-8001
Mailing Address - Fax:512-258-4106
Practice Address - Street 1:10418 LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1226
Practice Address - Country:US
Practice Address - Phone:512-258-8001
Practice Address - Fax:512-258-4106
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice