Provider Demographics
NPI:1003037789
Name:GRAHAM, ADRIANE KATHLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:ADRIANE
Middle Name:KATHLEEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1811
Mailing Address - Country:US
Mailing Address - Phone:310-742-6088
Mailing Address - Fax:310-742-6456
Practice Address - Street 1:128 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1811
Practice Address - Country:US
Practice Address - Phone:310-742-6088
Practice Address - Fax:310-742-6456
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist