Provider Demographics
NPI:1558956847
Name:DR EDITHANN GRAHAM PC
Entity Type:Organization
Organization Name:DR EDITHANN GRAHAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-440-2152
Mailing Address - Street 1:266 AVOCADO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4670
Mailing Address - Country:US
Mailing Address - Phone:619-440-2152
Mailing Address - Fax:619-440-2693
Practice Address - Street 1:266 AVOCADO AVE STE A
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4670
Practice Address - Country:US
Practice Address - Phone:619-440-2152
Practice Address - Fax:619-440-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty