Provider Demographics
NPI:1538379417
Name:R GRAHAM MCENTIRE DDS
Entity type:Organization
Organization Name:R GRAHAM MCENTIRE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:MCENTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-456-1200
Mailing Address - Street 1:3622 ENSIGN RD NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5081
Mailing Address - Country:US
Mailing Address - Phone:360-456-1200
Mailing Address - Fax:360-456-0213
Practice Address - Street 1:3622 ENSIGN RD NE
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5081
Practice Address - Country:US
Practice Address - Phone:360-456-1200
Practice Address - Fax:360-456-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007097261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental