Individual
DR. KATHERINE MARIE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
12672 NW BARNES RD, SUITE 101, PORTLAND, OR 97229-6016
(503) 644-9915
(503) 350-1275
Mailing address
10912 NW LUSANNE CT, PORTLAND, OR 97229-6172
(503) 671-9333
(503) 626-8366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6791
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000006791OR
DELTA DENTAL PAYEE NUMBER
OR
01
—
0005116600
AETNA PIN
OR
01
—
037212000
REGENCE BC/BS PROV ID
OR
05
—
046545
—
OR
Enumeration date
11/29/2005
Last updated
03/24/2016
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