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General NPI Number Information
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NPI Number | 1306578497
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Entity Type | Organization
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Legal Business Name | MARK GRAHAM, DDS, INC.
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 12/29/2024
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Provider Practice Location Address
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Address Line | 907 SAN RAMON VALLEY BLVD STE 104
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City | DANVILLE
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State | CA
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Zip | 94526-4036
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Country | US
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Telephone | 925-820-3000
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Fax | 866-763-0419
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Provider Business Mailing Address
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Address Line | 907 SAN RAMON VALLEY BLVD
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City | DANVILLE
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State | CA
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Zip | 94526-4144
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Country | US
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Telephone | 925-820-3000
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Fax | 866-763-0419
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARK GRAHAM
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Credential | DDS
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Telephone | 925-820-3000
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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 |
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License Number State |
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