Basic Information
| Provider Information | |||||||||
| NPI: | 1639277700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM-KREMERS | ||||||||
| FirstName: | AMA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170132421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170132421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS036878 | PA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1007543070048 | 05 | PA | MEDICAID | 1017665810003 | 05 | PA | MEDICAID | 1017665810012 | 05 | PA | MEDICAID | 1017665810016 | 05 | PA | MEDICAID | 1017665810002 | 05 | PA | MEDICAID | 1017665810001 | 05 | PA | MEDICAID | 1017665810015 | 05 | PA | MEDICAID | 1017665810010 | 05 | PA | MEDICAID | 1017665810011 | 05 | PA | MEDICAID | 1007543070009 | 05 | PA | MEDICAID | 1017665810013 | 05 | PA | MEDICAID | 1017665810014 | 05 | PA | MEDICAID |