Provider Demographics
NPI:1427229780
Name:DERSLEY, GRAHAM MICHAEL (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:MICHAEL
Last Name:DERSLEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 NATIONAL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1100
Mailing Address - Country:US
Mailing Address - Phone:301-421-1996
Mailing Address - Fax:240-455-4922
Practice Address - Street 1:3905 NATIONAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1100
Practice Address - Country:US
Practice Address - Phone:301-421-1996
Practice Address - Fax:240-455-4922
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics