Provider Demographics
NPI:1497959159
Name:GRAHAM, HOADIEP NGUYEN (DDS)
Entity Type:Individual
Prefix:
First Name:HOADIEP
Middle Name:NGUYEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HOA DIEP
Other - Middle Name:TRAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2818 NEUSE BLVD
Mailing Address - Street 2:CRAVEN COUTY HEALTH DEPT: DENTAL
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2850
Mailing Address - Country:US
Mailing Address - Phone:252-636-4920
Mailing Address - Fax:
Practice Address - Street 1:2818 NEUSE BLVD
Practice Address - Street 2:CRAVEN COUTY HEALTH DEPT: DENTAL
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2850
Practice Address - Country:US
Practice Address - Phone:252-636-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150621122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist