Provider Demographics
NPI:1275129116
Name:GRAHAM FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:GRAHAM FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-821-9212
Mailing Address - Street 1:6 BIRNAMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2415
Mailing Address - Country:US
Mailing Address - Phone:870-821-9212
Mailing Address - Fax:
Practice Address - Street 1:326 N ROSSER ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3247
Practice Address - Country:US
Practice Address - Phone:870-633-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4264OtherARKANSAS STATE BOARD OF DENTAL EXAMINERS