Provider Demographics
NPI:1164211017
Name:MATTHEW GRAHAM, DDS PLLC
Entity type:Organization
Organization Name:MATTHEW GRAHAM, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-635-9745
Mailing Address - Street 1:1107 WESTBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5013
Mailing Address - Country:US
Mailing Address - Phone:804-741-2812
Mailing Address - Fax:
Practice Address - Street 1:1107 WESTBRIAR DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-5013
Practice Address - Country:US
Practice Address - Phone:804-741-2812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental