Provider Demographics
NPI:1821062019
Name:GRAHAM MICHAUX, KERRI-ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRI-ANN
Middle Name:
Last Name:GRAHAM MICHAUX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 STERTHAUS DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5117
Mailing Address - Country:US
Mailing Address - Phone:850-227-4628
Mailing Address - Fax:
Practice Address - Street 1:802 STERTHAUS DR STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5132
Practice Address - Country:US
Practice Address - Phone:386-868-4483
Practice Address - Fax:321-445-5364
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075554100Medicaid