MEDICARE: DR. GRAHAM M PIERCE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901008277	MI

General Provider Information

NPI Number	:	1164482964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAHAM M PIERCE D.D.S.

Provider Business Mailing Address
First Line	:	289 E MAIN ST
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-1511
Country	:	US
Telephone Number	:	231-526-9611
Fax Number	:	231-526-2051

Provider Business Practice Location Address
First Line	:	289 E MAIN ST
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-1511
Country	:	US
Telephone Number	:	231-526-9611
Fax Number	:	231-526-2051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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