Provider Demographics
NPI:1184742587
Name:GRAMMER DENTAL CLINIC
Entity type:Organization
Organization Name:GRAMMER DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:GRAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:870-793-2482
Mailing Address - Street 1:184 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4609
Mailing Address - Country:US
Mailing Address - Phone:870-793-2482
Mailing Address - Fax:
Practice Address - Street 1:184 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4609
Practice Address - Country:US
Practice Address - Phone:870-793-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR24861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134973631Medicaid