Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5285 | KY |
N | 208200000X | Surgeon | 5285 | KY |
N | 208600000X | Surgeon | 5285 | KY |
NPI | 1104837962 |
---|---|
Provider Name | Dr. David Alan Graves |
First Address | Elizabethtown, KY 42701-2410 |
Second Address | Elizabethtown, KY 42701-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 02/07/2008 |