Individual provider Active NPI

Richard Francis Graham, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Jefferson City, MO
National Provider Identifier
1215043104
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2005022070 Issued in MO
Practice address
1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490
Phone
(573) 635-7216
Fax
(573) 635-2646
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2005022070 MO Primary

Addresses

Primary practice location

1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490

Mailing address

1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490
Phone (573) 635-7216

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2005022070MOMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202083200000",
    "number": "1215043104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "RICHARD",
        "middle_name": "FRANCIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2008-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2005022070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.