MEDICARE: DR. MEGAN GRAHAM DDS

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	122300000X	Dentist	6373-15	WI

General Provider Information

NPI Number	:	1174751523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN GRAHAM DDS

Provider Business Mailing Address
First Line	:	2524 E WEBSTER PL STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4257
Country	:	US
Telephone Number	:	414-963-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 E WEBSTER PL STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4257
Country	:	US
Telephone Number	:	414-963-9440
Fax Number	:

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	10/26/2020

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