Provider Demographics
NPI:1730898677
Name:GRAVES, LINDSAY COLLIS (RDH)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:COLLIS
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:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-0480
Mailing Address - Country:US
Mailing Address - Phone:423-337-5045
Mailing Address - Fax:
Practice Address - Street 1:206 MAYES AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2620
Practice Address - Country:US
Practice Address - Phone:423-337-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7637124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist