Provider Demographics
NPI:1215726336
Name:GRAMMEL, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:GRAMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E WATERLOO ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2101
Mailing Address - Country:US
Mailing Address - Phone:614-837-4113
Mailing Address - Fax:
Practice Address - Street 1:31 E WATERLOO ST
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2101
Practice Address - Country:US
Practice Address - Phone:614-837-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist