Healthcare Provider Details

I. General information

NPI: 1356038608
Provider Name (Legal Business Name): BRYAN GRAHAM AND KYLE MCKINNEY DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 13TH AVENUE PL NW STE 101
HICKORY NC
28601-2596
US

IV. Provider business mailing address

221 13TH AVENUE PL NW STE 102
HICKORY NC
28601-2596
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-5581
  • Fax: 828-322-1745
Mailing address:
  • Phone: 828-328-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN DOUGLAS GRAHAM
Title or Position: OFFICER
Credential: DDS
Phone: 828-328-5581