Provider Demographics
NPI:1497757801
Name:GRABER, MICHELLE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:GRABER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:CHRISTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7923332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies