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General NPI Number Information
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NPI Number | 1790873909
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Entity Type | Individual
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Provider Name | GREGORY H GRADY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4121 OKEMOS RD STE 20
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City | OKEMOS
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State | MI
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Zip | 48864-3220
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Country | US
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Telephone | 517-349-0388
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Fax | 517-349-1589
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Provider Business Mailing Address
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Address Line | 4121 OKEMOS RD STE 20
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City | OKEMOS
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State | MI
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Zip | 48864-3220
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Country | US
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Telephone | 517-349-0388
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Fax | 517-349-1589
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 015439
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License Number State | MI
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