Provider Demographics
NPI:1538244850
Name:GRAVES, ATHENA A (DDS)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:A
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 STATE ROUTE 3
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7472
Mailing Address - Country:US
Mailing Address - Phone:518-324-2273
Mailing Address - Fax:518-324-2276
Practice Address - Street 1:762 STATE ROUTE 3
Practice Address - Street 2:SUITE 1
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7472
Practice Address - Country:US
Practice Address - Phone:518-324-2273
Practice Address - Fax:518-324-2276
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice