Healthcare Provider Details

I. General information

NPI: 1336251578
Provider Name (Legal Business Name): MEGAN JURECKO GRACY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 NW 69TH TERRACE SUITE C
GAINESVILLE FL
32605
US

IV. Provider business mailing address

1204 NW 69TH TERRACE SUITE C
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3788
  • Fax: 352-332-3791
Mailing address:
  • Phone: 352-332-3788
  • Fax: 352-332-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN15992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: