Provider Demographics
NPI:1174958292
Name:GRAHAM, STEPHANIE LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 S HENDERSON RD
Mailing Address - Street 2:APT C407
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3529
Mailing Address - Country:US
Mailing Address - Phone:620-875-6498
Mailing Address - Fax:
Practice Address - Street 1:321 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1017
Practice Address - Country:US
Practice Address - Phone:610-626-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040136122300000X
MO2013032927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist