Provider Demographics
NPI:1376691097
Name:GRAMMER, FRANK C (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:C
Last Name:GRAMMER
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4185
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-4185
Mailing Address - Country:US
Mailing Address - Phone:479-717-1171
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:1708 E JOYCE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5252
Practice Address - Country:US
Practice Address - Phone:479-582-3002
Practice Address - Fax:479-582-2840
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19311223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58229OtherBCBS
194717OtherUNITED CONCORDIA
AR234282400OtherDEPT OF LABOR WORKERS COM
AR58229OtherBCBS