Provider Demographics
NPI:1477544336
Name:GRAHAM, JAMES MALLARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MALLARD
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 1:2937 LYNDALE AVE S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2171
Mailing Address - Country:US
Mailing Address - Phone:612-827-7400
Mailing Address - Fax:
Practice Address - Street 1:2937 LYNDALE AVE S
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2171
Practice Address - Country:US
Practice Address - Phone:612-827-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND99581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice