Provider Demographics
NPI:1932547114
Name:GRAVES, DANIEL TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TAYLOR
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1880
Mailing Address - Country:US
Mailing Address - Phone:402-376-3390
Mailing Address - Fax:402-376-2005
Practice Address - Street 1:331 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1880
Practice Address - Country:US
Practice Address - Phone:402-376-3390
Practice Address - Fax:402-376-2005
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice