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General NPI Number Information
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NPI Number | 1427229780
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Entity Type | Individual
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Provider Name | GRAHAM MICHAEL DERSLEY D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 3905 NATIONAL DR SUITE 260
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1100
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Country | US
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Telephone | 301-421-1996
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Fax | 240-455-4922
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Provider Business Mailing Address
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Address Line | 3905 NATIONAL DR SUITE 260
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City | BURTONSVILLE
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State | MD
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Zip | 20866-1100
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Country | US
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Telephone | 301-421-1996
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Fax | 240-455-4922
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 14033
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License Number State | MD
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