Provider Demographics
NPI:1649502493
Name:LEUPP, GRAHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:
Last Name:LEUPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9201
Mailing Address - Country:US
Mailing Address - Phone:530-672-2345
Mailing Address - Fax:
Practice Address - Street 1:3230 OXFORD RD
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9201
Practice Address - Country:US
Practice Address - Phone:530-672-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32737OtherDENTI-CAL PROVIDER #