MEDICARE: MATTHEW GRAHAM BERKELHAMMER 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	12840	NC

General Provider Information

NPI Number	:	1346972734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GRAHAM BERKELHAMMER DDS

Provider Business Mailing Address
First Line	:	116 S DRIVER ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-4134
Country	:	US
Telephone Number	:	336-455-2624
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 GARY ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2299
Country	:	US
Telephone Number	:	919-682-4861
Fax Number	:

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

Provider Enumeration Date	:	06/26/2022
Last Update Date	:	06/26/2022

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