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General NPI Number Information
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NPI Number | 1093942443
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Entity Type | Individual
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Provider Name | RYAN PATRICK GRADY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 126 WEST COLORADO AVE SUITE 203
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City | TELLURIDE
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State | CO
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Zip | 81435
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Country | US
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Telephone | 970-728-4336
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Fax | 970-369-4386
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Provider Business Mailing Address
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Address Line | PO BOX 3644
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City | TELLURIDE
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State | CO
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Zip | 81435-3644
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Country | US
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Telephone | 970-728-4336
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Fax | 970-369-4386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN-9922
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License Number State | CO
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