MEDICARE: DR. MICHAEL KEVIN O'GRADY D.D.S.

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	047465	NY

General Provider Information

NPI Number	:	1598899924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KEVIN O'GRADY D.D.S.

Provider Business Mailing Address
First Line	:	2101 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8017
Country	:	US
Telephone Number	:	631-666-6250
Fax Number	:	631-666-6256

Provider Business Practice Location Address
First Line	:	2101 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8017
Country	:	US
Telephone Number	:	631-666-6250
Fax Number	:	631-666-6256

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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