Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 44404 | CA |
NPI | 1003037789 |
---|---|
Provider Name | Adriane Kathleen Graham |
First Address | Inglewood, CA 90301-1811 |
Second Address | Inglewood, CA 90301-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 01/08/2017 |