MEDICARE: KATHRYN L. GRADY DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1235277146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRYN L. GRADY DDS, PC

Provider Business Mailing Address
First Line	:	700 E OGDEN AVE STE 302
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5554
Country	:	US
Telephone Number	:	630-789-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE STE 302
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5554
Country	:	US
Telephone Number	:	630-789-3903
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. KATHRYN L GRADY
Credential	:	DDS
Telephone Number	:	630-789-3803

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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