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General NPI Number Information
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NPI Number | 1720576671
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Entity Type | Organization
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Legal Business Name | JODI A MCGRADY DMD, MS, ADC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 12350 OAK KNOLL RD
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-748-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 12350 OAK KNOLL RD
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City | POWAY
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State | CA
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Zip | 92064-5320
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Country | US
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Telephone | 858-748-3090
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JODI A MCGRADY
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Credential | DMD
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Telephone | 858-748-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 57570
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License Number State | CA
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