Provider Demographics
NPI:1780447490
Name:LECROY GRAHAM & MCKINNEYDDS PLLC
Entity type:Organization
Organization Name:LECROY GRAHAM & MCKINNEYDDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-917-9218
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-1083
Mailing Address - Country:US
Mailing Address - Phone:828-295-9603
Mailing Address - Fax:
Practice Address - Street 1:123 LITTLE SPRING RD
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-8114
Practice Address - Country:US
Practice Address - Phone:828-295-9603
Practice Address - Fax:828-295-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty