Provider Demographics
NPI:1972748747
Name:GRAFF, DEREK JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAY
Last Name:GRAFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3180 N BUTLER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2336
Mailing Address - Country:US
Mailing Address - Phone:505-327-4884
Mailing Address - Fax:505-327-9089
Practice Address - Street 1:3180 N BUTLER AVE STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2336
Practice Address - Country:US
Practice Address - Phone:505-327-4884
Practice Address - Fax:505-327-9089
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD30861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics