MEDICARE: DR. GRAHAM MICHAEL DERSLEY D.D.S., M.S.

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	1223P0700X	Prosthodontics	14033	MD

General Provider Information

NPI Number	:	1427229780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAHAM MICHAEL DERSLEY D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3905 NATIONAL DR
Second Line	:	SUITE 260
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1100
Country	:	US
Telephone Number	:	301-421-1996
Fax Number	:	240-455-4922

Provider Business Practice Location Address
First Line	:	3905 NATIONAL DR
Second Line	:	SUITE 260
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1100
Country	:	US
Telephone Number	:	301-421-1996
Fax Number	:	240-455-4922

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	01/09/2009

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