Provider Demographics
NPI:1598970063
Name:GRAHAM, LAURA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11404 FOREST KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9752
Mailing Address - Country:US
Mailing Address - Phone:317-570-2144
Mailing Address - Fax:
Practice Address - Street 1:13450 NORTH MERIDIAN STREET
Practice Address - Street 2:SUITE 363
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7120
Practice Address - Country:US
Practice Address - Phone:317-846-5893
Practice Address - Fax:317-846-5878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry