Provider Demographics
NPI:1164789061
Name:HEARN, GRAHAM L (DDS)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:L
Last Name:HEARN
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 1:2650 21ST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2539
Mailing Address - Country:US
Mailing Address - Phone:916-277-8055
Mailing Address - Fax:916-266-7513
Practice Address - Street 1:1245 SE 3RD ST STE A1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2162
Practice Address - Country:US
Practice Address - Phone:541-318-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD119391223P0221X
WADE605405051223P0221X
CA1002611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry