Individual
KELLAN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
131 MONTGOMERY XING, BISCOE, NC 27209-9592
(910) 428-2048
Mailing address
250 SPRING LAKE DR, PINEHURST, NC 28374-7055
(386) 365-2706
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11933
NC
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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