Individual
MRS. LORETTA PROSSER GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
15410 WARWICK BLVD, NEWPORT NEWS, VA 23608-1576
(757) 886-9169
(757) 874-8892
Mailing address
15410 WARWICK BLVD, NEWPORT NEWS, VA 23608-1576
(757) 886-9169
(757) 874-8892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006225
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320574
ANTHEM BC/BS
VA
01
—
543768
UNITED CONCORDIA
VA
01
—
9178694
DORAL DENTAL
VA
Enumeration date
07/19/2006
Last updated
07/08/2007
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