NPIMap

Organization Active NPI

Outreach Dental, LLC

  • Dentist
  • Gallup, NM
National Provider Identifier
1982033700
Registry record updated Nov 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD1995 Issued in NM
Legal business name
OUTREACH DENTAL, LLC
Practice address
1700 Helena Dr
Gallup, NM 87301-5610
Phone
(505) 863-7887
Fax
(505) 863-7887
NPI assigned
Nov 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2013

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

Authorized official

Name
Dr. Stephen Scot Graham, D.D.S.
Title
Owner
Phone
(505) 863-7887

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DD1995 NM Primary

Addresses

Primary practice location

1700 Helena Dr
Gallup, NM 87301-5610

Mailing address

PO Box 969
Gallup, NM 87305-0969
Phone (505) 863-7887

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383350400000",
    "number": "1982033700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873050969",
            "telephone_number": "505-863-7887",
            "fax_number": "505-863-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HELENA DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015610",
            "telephone_number": "505-863-7887",
            "fax_number": "505-863-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "SCOT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-863-7887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2013; 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.