Provider Demographics
NPI:1952508137
Name:GRAHAM, FRASER HEARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRASER
Middle Name:HEARD
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 1:15321 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3700
Mailing Address - Country:US
Mailing Address - Phone:210-654-7878
Mailing Address - Fax:210-402-0410
Practice Address - Street 1:15321 SAN PEDRO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3700
Practice Address - Country:US
Practice Address - Phone:210-654-7878
Practice Address - Fax:210-402-0410
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics