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Individual

STEPHEN GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1996 DOUGS PARK ROAD, CAMP VERDE, AZ 86322
(928) 567-1832
(928) 567-6500
Mailing address
PO BOX 767, CAMP VERDE, AZ 86322-0767
(928) 567-1832
(928) 567-6500

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D4330
AZ
1223P0221X
Pediatric Dentistry
DD1995
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
114736
AZ
05
G2446
NM
Enumeration date
04/27/2007
Last updated
07/09/2007
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