Basic Information
| Provider Information | |||||||||
| NPI: | 1861476905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAZIANO | ||||||||
| FirstName: | JANELE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GIBSON | ||||||||
| OtherFirstName: | JANELE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DMD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 450 GIBNER RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1724545427 | ||||||||
| FaxNumber: | 7172453529 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 GIBNER RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172454542 | ||||||||
| FaxNumber: | 7172453529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS036516 | PA | Y | Dental Providers | Dentist |
No ID Information.