Provider Demographics
NPI:1184601791
Name:GRAVES, JEFFERY ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ROBERT
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROTARY WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8475
Mailing Address - Country:US
Mailing Address - Phone:707-642-0433
Mailing Address - Fax:707-642-5032
Practice Address - Street 1:19 ROTARY WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8475
Practice Address - Country:US
Practice Address - Phone:707-642-0433
Practice Address - Fax:707-642-5032
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30918204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery