Provider Demographics
NPI:1336319037
Name:GRAHAM, TATIANA N
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:N
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 OLD SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5684
Mailing Address - Country:US
Mailing Address - Phone:717-697-4002
Mailing Address - Fax:717-697-7810
Practice Address - Street 1:161 OLD SCHOOLHOUSE LN
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5684
Practice Address - Country:US
Practice Address - Phone:717-697-4002
Practice Address - Fax:717-697-7810
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO372211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice