1851378707 NPI number — SARAH E GRAFTON DMD

Table of content: SARAH E GRAFTON DMD (NPI 1851378707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851378707 NPI number — SARAH E GRAFTON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAFTON
Provider First Name:
SARAH
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851378707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SHENANGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16146-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-704-8886
Provider Business Mailing Address Fax Number:
724-342-1942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER FALLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15010-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-843-4400
Provider Business Practice Location Address Fax Number:
724-843-8728
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS031611L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019507860001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2411232 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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