Provider Demographics
NPI:1720579873
Name:GRAHAM, CAITLIN K (DDS)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:K
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 1:326 N ROSSER ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3247
Mailing Address - Country:US
Mailing Address - Phone:870-633-4591
Mailing Address - Fax:870-633-8460
Practice Address - Street 1:326 N ROSSER ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3247
Practice Address - Country:US
Practice Address - Phone:870-633-4591
Practice Address - Fax:870-633-8460
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4264OtherARKANSAS STATE BOARD OF DENTAL EXAMINERS