MEDICARE: DR. MARK ALAN GRAHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	54870	CA

General Provider Information

NPI Number	:	1023115896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN GRAHAM DDS

Provider Business Mailing Address
First Line	:	907 SAN RAMON VALLEY BLVD STE 104
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4036
Country	:	US
Telephone Number	:	925-820-3000
Fax Number	:	925-820-6293

Provider Business Practice Location Address
First Line	:	907 SAN RAMON VALLEY BLVD STE 104
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4036
Country	:	US
Telephone Number	:	925-820-3000
Fax Number	:	925-820-6293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/27/2024

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