Provider Demographics
NPI:1174965982
Name:GRAHAM, VICTORIA ESTER (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ESTER
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NORTHCHASE PKWY SE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6405
Mailing Address - Country:US
Mailing Address - Phone:678-904-5665
Mailing Address - Fax:
Practice Address - Street 1:401 S GLOSTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5540
Practice Address - Country:US
Practice Address - Phone:662-269-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3719-131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice