Provider Demographics
NPI:1619278306
Name:GRAHAM, ERIN RAE (RDH)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RAE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04289-5109
Mailing Address - Country:US
Mailing Address - Phone:207-674-6707
Mailing Address - Fax:
Practice Address - Street 1:20 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST PARIS
Practice Address - State:ME
Practice Address - Zip Code:04289-5109
Practice Address - Country:US
Practice Address - Phone:207-674-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2964124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist