Provider Demographics
NPI:1740314863
Name:GRAMS, MICHAEL STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:GRAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 E HWY 60
Mailing Address - Street 2:SUITE 110
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85218
Mailing Address - Country:US
Mailing Address - Phone:480-983-3444
Mailing Address - Fax:480-983-2177
Practice Address - Street 1:6900 E HWY 60
Practice Address - Street 2:SUITE 110
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85218
Practice Address - Country:US
Practice Address - Phone:480-983-3444
Practice Address - Fax:480-983-2177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7505122300000X
IN120090151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist