Active NPI
Kenneth Murdock Graves, D.D.S.
- Dentist
- Tacoma, WA
National Provider Identifier
1588680334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE7821
- Practice address
- A-112-Dent American Lake Vamc Dental Clinic
Tacoma, WA 98493-0001 - Phone
- (253) 589-4005
- Fax
- (253) 589-4162
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE7821 | WA | Primary |
Addresses
Primary practice location
A-112-Dent American Lake Vamc Dental Clinic
Tacoma, WA 98493-0001
Mailing address
23608 Rim Rd
Graham, WA 98338-7236
Phone (360) 893-6154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE7821 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588680334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23608 RIM RD",
"city": "GRAHAM",
"state": "WA",
"postal_code": "983387236",
"telephone_number": "360-893-6154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "A-112-DENT AMERICAN LAKE VAMC DENTAL CLINIC",
"city": "TACOMA",
"state": "WA",
"postal_code": "984930001",
"telephone_number": "253-589-4005",
"fax_number": "253-589-4162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVES",
"first_name": "KENNETH",
"middle_name": "MURDOCK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE7821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.