Provider Demographics
NPI:1770792517
Name:JAMES B GRAHAM DDSPA
Entity type:Organization
Organization Name:JAMES B GRAHAM DDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-264-2381
Mailing Address - Street 1:252 E KING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5080
Mailing Address - Country:US
Mailing Address - Phone:828-264-2381
Mailing Address - Fax:
Practice Address - Street 1:252 E KING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5080
Practice Address - Country:US
Practice Address - Phone:828-264-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty