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General NPI Number Information
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NPI Number | 1073785986
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Entity Type | Organization
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Legal Business Name | GREGORY M. GRAHAM, DMD,LLC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 385 MEADOW RIDGE DRIVE GREGORY M GRAHAM, DMD, LLC
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8741
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Country | US
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Telephone | 478-452-0270
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Fax | 478-454-1068
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Provider Business Mailing Address
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Address Line | 385 MEADOW RIDGE DR GREGORY M GRAHAM, DMD, LLC
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8741
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Country | US
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Telephone | 478-452-0270
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Fax | 478-454-1068
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. GREGORY M. GRAHAM
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Credential | DMD
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Telephone | 478-452-0270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN010029
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License Number State | GA
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