Individual
DR. WARREN KIRKLAND GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-9133
(505) 325-9113
Mailing address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-9133
(505) 325-9113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD816
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44933
—
NM
01
—
DD816
DENTAL LICENSE
NM
Enumeration date
07/15/2006
Last updated
07/09/2007
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