Healthcare Provider Details

I. General information

NPI: 1548556459
Provider Name (Legal Business Name): MEGAN JURECKO GRACY, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 NW 69TH TER SUITE C
GAINESVILLE FL
32605-3158
US

IV. Provider business mailing address

1204 NW 69TH TER SUITE C
GAINESVILLE FL
32605-3158
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 Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN JURECKO GRACY
Title or Position: OWNER
Credential: DMD
Phone: 352-332-3788