Edithann Jennings Graham, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

CA56651 Issued in CA

Practice address

1806 Cable St
San Diego, CA 92107-3103

Phone

(619) 226-4784

Fax

(619) 226-3027

NPI assigned

Jan 4, 2006

Last updated

Jul 17, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Edith Ann Jennings Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edithann J Graham DMD Ms Inc

  dba Ocean Beach Periodontics and Dental Implants

  • Periodontics
  • San Diego, CA
  • NPI 1255005153
  NPD Authorized official
• Edithann J Graham DMD Ms Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • San Diego, CA
  • NPI 1700460748
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247788800000",
    "number": "1063490639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921073103",
            "telephone_number": "619-226-4784",
            "fax_number": "619-226-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921073103",
            "telephone_number": "619-226-4784",
            "fax_number": "619-226-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "EDITHANN",
        "middle_name": "JENNINGS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2009-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "5253",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "CA56651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDITH",
            "last_name": "JENNINGS",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alison Nicole Graham, D.O.
• Barbara Ann Graham, MSW
• Benjamin Graham, IDC
• Cody Ryan Graham
• Debra Jeanne Graham, DNP
• Elizabeth Graham, RBT
• Genesis Graham
• George Henry Graham III, PH.D.
• Gloria Mae Graham, SUDCC III
• Heather Lynn Graham, RN

• Periodontics in San Diego, CA
• Providers in San Diego, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.