MEDICARE: MATTHEW GRAHAM, DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1164211017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW GRAHAM, DDS PLLC

Provider Business Mailing Address
First Line	:	1107 WESTBRIAR DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-5013
Country	:	US
Telephone Number	:	804-741-2812
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 WESTBRIAR DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-5013
Country	:	US
Telephone Number	:	804-741-2812
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MATTHEW CHRISTIAN GRAHAM
Credential	:	DDS
Telephone Number	:	757-635-9745

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/24/2025

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