Individual
ANTHONY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 W LAKE MARY BLVD, SUITE- 106, LAKE MARY, FL 32746-3501
(407) 328-6411
Mailing address
2502 N ROCKY POINT DR, SUITE 1000- CREDENTIALING, TAMPA, FL 33607-1421
(813) 288-1999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15163
FL
Other
Enumeration date
05/12/2008
Last updated
05/12/2008
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