Provider Demographics
NPI:1639550577
Name:GRAHAM, BARBARA ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANNE
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 1:738 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1336
Mailing Address - Country:US
Mailing Address - Phone:203-437-6213
Mailing Address - Fax:
Practice Address - Street 1:738 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1336
Practice Address - Country:US
Practice Address - Phone:203-437-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT114121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice