Provider Demographics
NPI:1881607117
Name:GRAHAM, EMILY ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELLEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 KUYKENDAHL RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:281-351-2090
Mailing Address - Fax:281-516-7950
Practice Address - Street 1:21301 KUYKENDAHL RD.
Practice Address - Street 2:SUITE D
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-351-2090
Practice Address - Fax:281-516-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist