MEDICARE: EDWARD J MCGRATH DDS

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	122300000X	Dentist	5538-15	WI

General Provider Information

NPI Number	:	1578567509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD J MCGRATH DDS

Provider Business Mailing Address
First Line	:	400 S TOWNLINE RD
Second Line	:
City	:	WAUTOMA
State	:	WI
Zip	:	54982-6922
Country	:	US
Telephone Number	:	920-787-5514
Fax Number	:	920-787-4737

Provider Business Practice Location Address
First Line	:	5764 WINDY DR
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54482-8486
Country	:	US
Telephone Number	:	920-787-5514
Fax Number	:	920-787-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/14/2025

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