Provider Demographics
NPI:1952030249
Name:LANSDALE-GRAVES, VICTORIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:LANSDALE-GRAVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LANSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-4145
Mailing Address - Country:US
Mailing Address - Phone:731-695-9863
Mailing Address - Fax:
Practice Address - Street 1:1201 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2700
Practice Address - Country:US
Practice Address - Phone:731-479-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN119061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice