Provider Demographics
NPI:1629174594
Name:GRAHAM, BARRY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
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 1:3635 OLD COURT RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-484-5800
Mailing Address - Fax:410-486-8939
Practice Address - Street 1:3635 OLD COURT RD
Practice Address - Street 2:SUITE 510
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-5800
Practice Address - Fax:410-486-8939
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8420OtherBLUE CROSS BLUE SHIELD