Provider Demographics
NPI:1245441286
Name:GRABE, AMELIA MERCHANT (DMD)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:MERCHANT
Last Name:GRABE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMELIA
Other - Middle Name:GRABE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:P. O. BOX 389
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-0389
Mailing Address - Country:US
Mailing Address - Phone:603-826-5766
Mailing Address - Fax:603-826-5767
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603-4910
Practice Address - Country:US
Practice Address - Phone:603-826-5766
Practice Address - Fax:603-826-5767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT106806122300000X
ME3788122300000X
MA214911223G0001X
NH35031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1245441286OtherNPI