Provider Demographics
NPI:1417570789
Name:GRAHAM GRAY, LORI (DMD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:GRAHAM GRAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:896 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2367
Mailing Address - Country:US
Mailing Address - Phone:706-935-2251
Mailing Address - Fax:
Practice Address - Street 1:896 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2367
Practice Address - Country:US
Practice Address - Phone:706-935-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice