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General NPI Number Information
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NPI Number | 1033953641
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Entity Type | Organization
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Legal Business Name | C & N GRATHWOL DMD P.C.
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1108 E OGDEN AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-8560
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Country | US
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Telephone | 630-778-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1980 CLOVER DR
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City | INVERNESS
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State | IL
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Zip | 60067-4642
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Country | US
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Telephone | 419-357-1160
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. CORY ALAN GRATHWOL
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Credential | DMD
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Telephone | 419-357-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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