Healthcare Provider Details

I. General information

NPI: 1902563612
Provider Name (Legal Business Name): CATHERINE J GRAHAM DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 AL HIGHWAY 157 STE A
CULLMAN AL
35058-0672
US

IV. Provider business mailing address

1482 STONEWATER DR
CULLMAN AL
35055-1108
US

V. Phone/Fax

Practice location:
  • Phone: 256-398-6502
  • Fax: 256-398-6505
Mailing address:
  • Phone: 205-310-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CATHERINE JANE GRAHAM
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DMD
Phone: 256-398-6502