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Provider Information for 1588943484



DR. GRACE HARRIMAN DDS

Gender: FEMALE

Individual NPI: 1588943484

Calendar Last Updated: 2017-03-13

Details

Name Value
NPI 1588943484
Enumeration Date 2011-08-09
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 6573 ROOSEVELT BLVD
PHILADELPHIA, PA 19149
United States

Phone: 267-668-8001 | Fax: 267-668-8002
View Map External Link
Primary Practice Address 6573 ROOSEVELT BLVD
PHILADELPHIA, PA 19149
United States

Phone: 267-668-8001 | Fax: 267-668-8002
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist PA DS039072
No 1223G0001X - Dentist General Practice PA DS039072
Other Identifiers
Issuer State Number