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NPI Code Detail

MEDICARE: LAKECIA GRAHAM DH

MEDICARE: LAKECIA GRAHAM DH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental HygienistDH012564LPA

General Provider Information

NPI Number : 1588718183
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKECIA GRAHAM DH
Provider Business Mailing Address
First Line : 432 N 6TH ST
Second Line :
City : PHILA
State : PA
Zip : 19123-4004
Country : US
Telephone Number : 215-925-2400
Fax Number : 215-925-4201
Provider Business Practice Location Address
First Line : 626 SNYDER AVE
Second Line :
City : PHILA
State : PA
Zip : 19148-2419
Country : US
Telephone Number : 215-334-4900
Fax Number : 215-334-9721
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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Directions to “ LAKECIA GRAHAM DH” Practice Location

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