Provider Demographics
NPI:1780892133
Name:GRAHAM, BRYAN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DOUGLAS
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 1:221 13TH AVENUE PL NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2596
Mailing Address - Country:US
Mailing Address - Phone:828-328-5581
Mailing Address - Fax:828-322-1745
Practice Address - Street 1:221 13TH AVENUE PL NW
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2596
Practice Address - Country:US
Practice Address - Phone:828-328-5581
Practice Address - Fax:828-322-1745
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist