MEDICARE: LAURA GRAMSE, DMD PC

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
1	1223G0001X	General Practice Dentistry	DN18803	MA

General Provider Information

NPI Number	:	1902357049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA GRAMSE, DMD PC

Provider Business Mailing Address
First Line	:	2194 WILBRAHAM RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2194 WILBRAHAM RD
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01129-1810
Country	:	US
Telephone Number	:	413-783-6907
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	DR. LAURA GRAMSE
Credential	:
Telephone Number	:	413-783-6907

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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