Provider Demographics
NPI:1235142506
Name:GRAVES, ANDREW EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EDWARD
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 1:621 HELEN KELLER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2962
Mailing Address - Country:US
Mailing Address - Phone:205-633-6363
Mailing Address - Fax:205-633-6372
Practice Address - Street 1:621 HELEN KELLER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2962
Practice Address - Country:US
Practice Address - Phone:205-633-6363
Practice Address - Fax:205-633-6372
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL46381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics