Provider Demographics
NPI:1407980998
Name:BURCHAM, GRAHAM B (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:B
Last Name:BURCHAM
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 1:216 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2505
Mailing Address - Country:US
Mailing Address - Phone:615-595-6111
Mailing Address - Fax:615-595-9514
Practice Address - Street 1:216 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2505
Practice Address - Country:US
Practice Address - Phone:615-595-6111
Practice Address - Fax:615-595-9514
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice