DR. EDITHANN JENNINGS GRAHAM DMD NPI 1063490639

NPI Information

NPI: 1063490639
Provider Name: DR. EDITHANN JENNINGS GRAHAM, DMD
Classification: Dentist - 1223P0300X
Entity Type: Individual

Specialization: Periodontics

PECOS Registration: Yes

Address:
1806 CABLE ST
SAN DIEGO, CA
ZIP 92107
Phone: (619) 226-4784
Get Directions

DR. Edithann Jennings Graham, DMD is a periodontics dentist in San Diego, CA. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. DR. Edithann Jennings Graham, DMD NPI is 1063490639. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1806 CABLE ST
SAN DIEGO, CA
ZIP 92107-103
Phone: (619) 226-4784
Fax: (619) 226-3027

The NPI 1063490639 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 1/4/2006 and was last updated on 7/17/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0300X	Dentist	Periodontics	5253	ARIZONA	No
2	1223P0300X	Dentist	Periodontics	CA56651	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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