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General NPI Number Information
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NPI Number | 1578372892
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Entity Type | Organization
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Legal Business Name | GRADY ORTHODONTICS LLC
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 300 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5794
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Country | US
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Telephone | 816-524-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 300 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5794
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Country | US
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Telephone | 816-524-1111
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | PATRICK P GRADY
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Credential | DDS
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Telephone | 931-237-4332
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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 |
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License Number State |
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