Provider Demographics
NPI:1255210043
Name:GRAVES, REBECCA (RDH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC 3DA, PO BOX 30001
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:575-528-7071
Mailing Address - Fax:
Practice Address - Street 1:3400 S. ESPINA ST.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-528-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH-1060124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist