Provider Demographics
NPI:1194619189
Name:GRAHAM, SPENCER MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:MATTHEW
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 US HIGHWAY 131 S
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-7080
Mailing Address - Country:US
Mailing Address - Phone:231-775-9797
Mailing Address - Fax:231-775-9793
Practice Address - Street 1:7800 US HIGHWAY 131 S
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7080
Practice Address - Country:US
Practice Address - Phone:231-775-9797
Practice Address - Fax:231-775-9793
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016025581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice