MEDICARE: WM GRAHAM GARDNER DDS PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401008926	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972513208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WM GRAHAM GARDNER DDS PC

Provider Business Mailing Address
First Line	:	1206 WILLOW LAWN DRIVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1409
Country	:	US
Telephone Number	:	804-282-6436
Fax Number	:	804-282-8297

Provider Business Practice Location Address
First Line	:	1206 WILLOW LAWN DRIVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1409
Country	:	US
Telephone Number	:	804-282-6436
Fax Number	:	804-282-8297

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM GRAHAM GARDNER
Credential	:	DDS
Telephone Number	:	804-282-6436

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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