Gary B Graves, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6697 Issued in CO

Practice address

2099 W US Highway 50
Suite 120
Pueblo, CO 81008-1672

Phone

(719) 542-3595

Fax

(719) 543-5665

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Health Services PC

  • General Practice Dentistry
  • Pueblo, CO
  • NPI 1205847480
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487877957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2099 W US HIGHWAY 50",
            "address_2": "SUITE 120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081672",
            "telephone_number": "719-542-3595",
            "fax_number": "719-543-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2099 W US HIGHWAY 50",
            "address_2": "SUITE 120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081672",
            "telephone_number": "719-542-3595",
            "fax_number": "719-543-5665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "GARY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "6697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02066975",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48952346",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Graham, M.A.
• Robert Joseph Graham, DC
• Gregory Charles Grahek, NP-BC
• Jeanette Grant, L.C.S.W.
• Carrie Raye Gravatt, M.A., CCC-SLP
• Jeanne Ellen Graves, RDH
• Felicia Gray
• Jim Gray
• Wendy M Gray, FNP
• Zach James Gray, M.AC.O.M.,L.AC

• General Practice Dentistry in Pueblo, CO
• Providers in Pueblo, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.