Brendan David Graham, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019028327 Issued in IL

Practice address

318 N Bloomington St
Streator, IL 61364-2218

Phone

(815) 672-2647

Fax

(815) 672-5201

NPI assigned

Aug 11, 2010

Sex

Male

Sole proprietor

Yes

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 IL

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

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1962717207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 N BLOOMINGTON ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642218",
            "telephone_number": "815-672-2647",
            "fax_number": "815-672-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 N BLOOMINGTON ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642218",
            "telephone_number": "815-672-2647",
            "fax_number": "815-672-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BRENDAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Gillette
• Kristi Gleim
• Glenwood House Residential Care, Inc.
• Tami Jo Godfrey, PTA
• Good Shepard Medical Equipment Inc.
• Leah Gravesen
• Leah Gray, LPN
• John Groesbeck III, RPH
• Joan A Hallam, LCSW
• Jolene R Hancock, PT

• General Practice Dentistry in Streator, IL
• Providers in Streator, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; 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.