MEDICARE: DR. MATTHEW C 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	1223G0001X	General Practice Dentistry	0401416069	VA

General Provider Information

NPI Number	:	1184105645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW C GRAHAM DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	05/24/2025

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