Provider Demographics
NPI:1093857476
Name:GRAHAM, GERARD FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:FRANCIS
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WHITE PINE TERRACE
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089
Mailing Address - Country:US
Mailing Address - Phone:860-606-0066
Mailing Address - Fax:860-606-0071
Practice Address - Street 1:100 SIMSBURY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-606-0066
Practice Address - Fax:860-606-0071
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice