Healthcare Provider Details

I. General information

NPI: 1376691097
Provider Name (Legal Business Name): FRANK C GRAMMER DDS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E JOYCE BLVD SUITE 2
FAYETTEVILLE AR
72703-5252
US

IV. Provider business mailing address

PO BOX 4185
FAYETTEVILLE AR
72702-4185
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-3002
  • Fax: 479-582-2840
Mailing address:
  • Phone: 479-717-1171
  • Fax: 479-725-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1931
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number1931
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: