Active NPI
Brad Austin Graham, DMD
- Dentist
- Bowling Green, KY
National Provider Identifier
1255591384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- KY8362
- Practice address
- 1857 Tucker Way
Bowling Green, KY 40104 - Phone
- (270) 781-2952
- Fax
- (270) 793-0977
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | KY8362 | KY | Primary |
Addresses
Primary practice location
1857 Tucker Way
Bowling Green, KY 40104
Mailing address
1857 Tucker Way
Bowling Green, KY 40104
Phone (270) 781-2952
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY8362 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eli Jackson III PSC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Bowling Green, KY
- NPI 1447638168
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1255591384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1857 TUCKER WAY",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "40104",
"telephone_number": "270-781-2952",
"fax_number": "270-797-0977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1857 TUCKER WAY",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "40104",
"telephone_number": "270-781-2952",
"fax_number": "270-793-0977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "BRAD",
"middle_name": "AUSTIN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "KY8362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.