Provider Demographics
NPI:1598978058
Name:GRAHAM, KIRKLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRKLAND
Middle Name:
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 1:620 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1828
Mailing Address - Country:US
Mailing Address - Phone:801-466-6645
Mailing Address - Fax:801-466-6649
Practice Address - Street 1:620 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1828
Practice Address - Country:US
Practice Address - Phone:801-466-6645
Practice Address - Fax:801-466-6649
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4954-5951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice