Graciela Grammer, DDS
Individual provider Active NPI Dentist · Canton, IL
NPI 1982829420 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1982829420
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 01915408 (IL)
- Practice address
- 700 E Oak St
Canton, IL 61520-3157 - Phone
- (309) 647-1134
- Fax
- (309) 647-9545
- NPI assigned
- Apr 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01915408 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Fulton | Past | Accepting new patients | |
| Fulton County Health Department | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 01915408 | IL | Yes |
Addresses
Primary practice location
700 E Oak St
Canton, IL 61520-3157
Mailing address
522 S Cass St
Virginia, IL 62691-1506
Phone (217) 452-7207
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002038 | Medicaid | IL |
Other providers in Canton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.