Healthcare Provider Details

I. General information

NPI: 1154259133
Provider Name (Legal Business Name): ANDREW RICHARD GRAHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

405 BUFFALO RIDGE ST
LOUISVILLE OH
44641-8997
US

V. Phone/Fax

Practice location:
  • Phone: 330-471-5950
  • Fax:
Mailing address:
  • Phone: 330-936-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: