Provider Demographics
NPI:1881745024
Name:GRAHAM, JEFFREY M (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
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 1:4767 HIGHWAY 58
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-2231
Mailing Address - Country:US
Mailing Address - Phone:423-894-5223
Mailing Address - Fax:423-894-5224
Practice Address - Street 1:4767 HIGHWAY 58
Practice Address - Street 2:SUITE 125
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-2231
Practice Address - Country:US
Practice Address - Phone:423-894-5223
Practice Address - Fax:423-894-5224
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist