Rontae Marvell Edward Graham, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4677 Issued in AR

Practice address

3801 S Olive St
Pine Bluff, AR 71603

Phone

(870) 536-6917

Fax

(870) 536-4404

NPI assigned

Jun 7, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Garrett Taylor, DDS, PA

  • Dentist
  • Pine Bluff, AR
  • NPI 1013576933
  NPD (past)

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1700570140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 S OLIVE ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-536-6917",
            "fax_number": "870-536-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 S OLIVE ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-536-6917",
            "fax_number": "870-536-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "RONTAE",
        "middle_name": "MARVELL EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "4677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Gordon
• Nikki Pepino Gordon, RPT
• O T Gordon Jr., M.D.
• Jeffrey Tad Goss, PHARMD
• Shacoya Latrece Grady, LPN
• Rebecca Grandy, APN
• Gray-Millenbaugh Practitioner Healthcare, LLC
• Stacy Gray, RN
• Arriel S Green, BS, MS, MHPP
• Hillary Green, LCSW

• General Practice Dentistry in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.