| Organization Name: | GREGORY M. GRAHAM, DMD,LLC |
| NPI Number: | 1073785986 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY M. GRAHAM (DOCTOR/OWNER) |
| Mailing Address: | 385 Meadow Ridge Drive Gregory M Graham, Dmd, Llc Milledgeville |
| State: | GA US |
| Postal Code: | 310618741 |
| Phone Number: | 4784520270 |
| Fax Number: | 4784541068 |
| NPI Enumeration Date: | 03/31/2008 |
| NPI Last Update Date: | 07/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DN010029 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |