Healthcare Provider Details

I. General information

NPI: 1396807475
Provider Name (Legal Business Name): GERALD M. GRAHAM D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 NORTH MAPLE STREET
MUENSTER TX
76252-2426
US

IV. Provider business mailing address

P.O. BOX 709
MUENSTER TX
76252-0709
US

V. Phone/Fax

Practice location:
  • Phone: 940-759-2239
  • Fax: 940-759-4777
Mailing address:
  • Phone: 940-759-2239
  • Fax: 940-759-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8779
License Number StateTX

VIII. Authorized Official

Name: DR. GERALD M. GRAHAM
Title or Position: DENTIST
Credential: D.D.S.
Phone: 940-759-2239