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Organization
BILLY J GRAHAM
Active
Organization
BILLY J GRAHAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILLY JOE GRAHAM DDS (OWNER/DENTIST)
(479) 474-2701
Entity
Organization
Contact information
Practice address
611 JEFFERSON ST, VAN BUREN, AR 72956
(479) 474-2701
(479) 474-3977
Mailing address
PO BOX 475, VAN BUREN, AR 72957-0475
(479) 474-2701
(479) 474-3977
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
152
AR
122300000X
Dentist
1930
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58238
BCBS
AR
01
—
843764
UNITED CONCORDIA
AR
Enumeration date
08/22/2006
Last updated
08/22/2020
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