MEDICARE: R GRAHAM MCENTIRE 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	261QD0000X	Dental Clinic/Center	DE00007097	WA

General Provider Information

NPI Number	:	1538379417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R GRAHAM MCENTIRE DDS

Provider Business Mailing Address
First Line	:	3622 ENSIGN RD NE
Second Line	:	SUITE D
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5081
Country	:	US
Telephone Number	:	360-456-1200
Fax Number	:	360-456-0213

Provider Business Practice Location Address
First Line	:	3622 ENSIGN RD NE
Second Line	:	SUITE D
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5081
Country	:	US
Telephone Number	:	360-456-1200
Fax Number	:	360-456-0213

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD GRAHAM MCENTIRE
Credential	:	DDS
Telephone Number	:	360-456-1200

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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