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NPI Code Detail

MEDICARE: DR. LAURA B. GRAHAM D.D.S.

MEDICARE: DR. LAURA B. GRAHAM D.D.S.
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
11223P0221XPediatric Dentistry12008774IN

General Provider Information

NPI Number : 1598970063
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA B. GRAHAM D.D.S.
Provider Business Mailing Address
First Line : 11404 FOREST KNOLL CIR
Second Line :
City : FISHERS
State : IN
Zip : 46037-9752
Country : US
Telephone Number : 317-570-2144
Fax Number :
Provider Business Practice Location Address
First Line : 13450 NORTH MERIDIAN STREET
Second Line : SUITE 363
City : CARMEL
State : IN
Zip : 46032-7120
Country : US
Telephone Number : 317-846-5893
Fax Number : 317-846-5878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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