Individual
TABBITHA GRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1122 N 25TH ST, SUITE E, RICHMOND, VA 23223-5254
(804) 649-0240
(804) 643-4733
Mailing address
3216 EDGEWOOD AVE, RICHMOND, VA 23222-2508
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411441
VA
Other
Enumeration date
10/12/2006
Last updated
09/19/2012
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