MEDICARE: DR. KATHRYN L GRADY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1215002555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN L GRADY D.D.S.

Provider Business Mailing Address
First Line	:	14039 CHESTNUT COURT
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467
Country	:	US
Telephone Number	:	708-301-4363
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE STE 302
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5554
Country	:	US
Telephone Number	:	630-789-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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