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NPI Code Detail

MEDICARE: DIANA ELAINE GRAHAM RDH, MS

MEDICARE: DIANA ELAINE GRAHAM RDH, MS
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
1124Q00000XDental HygienistDH3207NM

General Provider Information

NPI Number : 1942645585
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA ELAINE GRAHAM RDH, MS
Provider Business Mailing Address
First Line : 4400 CUTLER AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-3935
Country : US
Telephone Number : 505-881-1234
Fax Number :
Provider Business Practice Location Address
First Line : 4400 CUTLER AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-3935
Country : US
Telephone Number : 505-881-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2013
Last Update Date : 05/02/2014

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