# EDITHANN J GRAHAM DMD MS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700460748
- **Authorized official:** EDITHANN GRAHAM DMD (OWNER)
- **Authorized official phone:** (619) 226-4784

## Contact information

- **Practice address:** 1806 CABLE ST, SAN DIEGO, CA 92107-3103
- **Practice address phone:** (619) 226-4784
- **Practice address fax:** (619) 226-3027
- **Mailing address:** 1806 CABLE ST, SAN DIEGO, CA 92107-3103
- **Mailing address phone:** (619) 226-4784
- **Mailing address fax:** (619) 226-3027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/06/2021
- **Last updated:** 05/06/2021