Provider Demographics
NPI:1831205004
Name:DE GRAFFENRIED, JOSEPH CLAUDE JR (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CLAUDE
Last Name:DE GRAFFENRIED
Suffix:JR
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 1:238 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662
Mailing Address - Country:US
Mailing Address - Phone:903-984-0614
Mailing Address - Fax:903-984-3834
Practice Address - Street 1:238 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662
Practice Address - Country:US
Practice Address - Phone:903-984-0614
Practice Address - Fax:903-984-3834
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice