Individual provider Active NPI

Stephanie Lynne Graham, D.D.S.

  • Dentist
  • Lansdowne, PA
National Provider Identifier
1174958292
Registry record updated Jul 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS040136 Issued in PA
Practice address
321 N Lansdowne Ave
Lansdowne, PA 19050-1017
Phone
(610) 626-5080
NPI assigned
Sep 9, 2013
Last updated
Jul 20, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS040136 PA Primary
Dentist 122300000X 2013032927 MO

Addresses

Primary practice location

321 N Lansdowne Ave
Lansdowne, PA 19050-1017

Mailing address

649 S Henderson Rd
Apt C407
King of Prussia, PA 19406-3529
Phone (620) 875-6498

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181018000264 PA Practitioner - Dentist 1951622042 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2013032927MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Silvana Cumani DMD and Associates PC CurrentSince Aug 29, 2018 Accepting new patients
Brilliant Smiles Dental Group - Lansdowne LLC Past Accepting new patients
Lansdowne Dental Health LLC Past Accepting new patients

Locations

2675 E Cumberland St
Philadelphia, PA 19125
Phone (215) 426-7307

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1174958292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 S HENDERSON RD",
            "address_2": "APT C407",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063529",
            "telephone_number": "620-875-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N LANSDOWNE AVE",
            "city": "LANSDOWNE",
            "state": "PA",
            "postal_code": "190501017",
            "telephone_number": "610-626-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "STEPHANIE",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS040136",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2013032927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansdowne, PA

Sources for this page

Verify at the official NPI Registry.