Healthcare Provider Details

I. General information

NPI: 1679602940
Provider Name (Legal Business Name): JOHN PATRICK MCGRANE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-5571
US

IV. Provider business mailing address

3605 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-5571
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-2281
  • Fax: 319-294-5783
Mailing address:
  • Phone: 319-294-2281
  • Fax: 319-294-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number07401
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: