Theodore Graham, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE60432317 Issued in WA

Practice address

626 Second Avenue
Okanogan, WA 98840-9679

Phone

(509) 422-5700

Fax

(509) 422-7680

NPI assigned

Feb 20, 2014

Last updated

Feb 20, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Choctaw Nation of Oklahoma

  dba Choctaw Nation Health Care

  • Rural Acute Care Hospital
  • Talihina, OK
  • NPI 1659347623
  NPD (past)

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1417372913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1340",
            "city": "OKANOGAN",
            "state": "WA",
            "postal_code": "988401340",
            "telephone_number": "509-422-5700",
            "fax_number": "509-422-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 SECOND AVENUE",
            "city": "OKANOGAN",
            "state": "WA",
            "postal_code": "988409679",
            "telephone_number": "509-422-5700",
            "fax_number": "509-422-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "THEODORE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-20",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60432317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Health Centers Dental
• Family Health Centers Omak (Advance)
• Jessica Marie Fodge, L.M.T.
• Teresa Rene Good, RN, IBCLC
• Grace Medical Supply LLC
• Denny Willis Homer, DMD
• Roy Huffstetler, PA-C
• J and S Drug
• Ryann Joy Joyner, LMT
• Gurpreet Kaur

• Dentist in Okanogan, WA
• Providers in Okanogan, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.