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General NPI Number Information
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NPI Number | 1336878693
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Entity Type | Individual
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Provider Name | JUSTIN THOMAS GRAHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2242 ASHLEY OAKS CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6404
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Country | US
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Telephone | 813-991-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 2242 ASHLEY OAKS CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6404
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Country | US
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Telephone | 813-991-5300
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Fax | 888-520-4252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN27000
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License Number State | FL
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