Provider Demographics
NPI:1053534941
Name:BRAD W. GRAFF D.M.D. PA
Entity type:Organization
Organization Name:BRAD W. GRAFF D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-963-3706
Mailing Address - Street 1:3107 STIRLING RD
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6565
Mailing Address - Country:US
Mailing Address - Phone:954-963-3706
Mailing Address - Fax:954-963-1223
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:SUITE # 108
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6565
Practice Address - Country:US
Practice Address - Phone:954-963-3706
Practice Address - Fax:954-963-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty