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General NPI Number Information
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NPI Number | 1598970063
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Entity Type | Individual
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Provider Name | LAURA B. GRAHAM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13450 NORTH MERIDIAN STREET SUITE 363
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City | CARMEL
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State | IN
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Zip | 46032-7120
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Country | US
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Telephone | 317-846-5893
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Fax | 317-846-5878
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Provider Business Mailing Address
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Address Line | 11404 FOREST KNOLL CIR
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City | FISHERS
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State | IN
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Zip | 46037-9752
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Country | US
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Telephone | 317-570-2144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12008774
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License Number State | IN
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