1376691097 NPI number — DR. FRANK C GRAMMER DDS, PHD

Table of content: DR. FRANK C GRAMMER DDS, PHD (NPI 1376691097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376691097 NPI number — DR. FRANK C GRAMMER DDS, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAMMER
Provider First Name:
FRANK
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, PHD
Provider Gender Code:
M

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:
1376691097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72702-4185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-717-1171
Provider Business Mailing Address Fax Number:
479-725-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 E JOYCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-582-3002
Provider Business Practice Location Address Fax Number:
479-582-2840
Provider Enumeration Date:
01/08/2007

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: 1223S0112X , with the licence number:  1931 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X , with the licence number: 1931 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 58229 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 194717 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 234282400 . This is a "DEPT OF LABOR WORKERS COM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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