Provider Demographics
NPI:1013204361
Name:GRAHAM FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GRAHAM FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-654-9383
Mailing Address - Street 1:2130 NE LOOP 410
Mailing Address - Street 2:STE. 225
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4659
Mailing Address - Country:US
Mailing Address - Phone:210-654-9383
Mailing Address - Fax:210-654-0570
Practice Address - Street 1:2130 NE LOOP 410
Practice Address - Street 2:STE. 225
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4659
Practice Address - Country:US
Practice Address - Phone:210-654-9383
Practice Address - Fax:210-654-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12837122300000X
TX224631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073725693OtherNPI
TX1629097183OtherNPI