Provider Demographics
NPI:1134504004
Name:MICHELLE GRABER DMD PC
Entity Type:Organization
Organization Name:MICHELLE GRABER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-259-8641
Mailing Address - Street 1:18425 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3932
Mailing Address - Country:US
Mailing Address - Phone:503-259-8641
Mailing Address - Fax:503-259-3261
Practice Address - Street 1:18425 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-3932
Practice Address - Country:US
Practice Address - Phone:503-259-8641
Practice Address - Fax:503-259-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty