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General NPI Number Information
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NPI Number | 1336251578
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Entity Type | Individual
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Provider Name | MEGAN JURECKO GRACY DMD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1204 NW 69TH TERRACE SUITE C
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City | GAINESVILLE
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State | FL
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Zip | 32605
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Country | US
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Telephone | 352-332-3788
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Fax | 352-332-3791
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Provider Business Mailing Address
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Address Line | 1204 NW 69TH TERRACE SUITE C
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City | GAINESVILLE
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State | FL
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Zip | 32605
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Country | US
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Telephone | 352-332-3788
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Fax | 352-332-3791
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN15992
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License Number State | FL
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