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General NPI Number Information
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NPI Number | 1396398384
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Entity Type | Individual
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Provider Name | GRAHAM BUSBY DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 1222 S KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73003-5855
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Country | US
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Telephone | 405-341-8518
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 SHERWOOD LN APT 217
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City | NICHOLS HILLS
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State | OK
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Zip | 73116-6517
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Country | US
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Telephone |
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7185
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License Number State | OK
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