Provider Demographics
NPI:1528620937
Name:GRAHAM, CATHERINE JANE (DMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 AL HIGHWAY 157 STE A
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0672
Mailing Address - Country:US
Mailing Address - Phone:256-398-6502
Mailing Address - Fax:
Practice Address - Street 1:1965 AL HIGHWAY 157 STE A
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0672
Practice Address - Country:US
Practice Address - Phone:205-310-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM20441223P0221X
ALD-0006956-C11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry