Provider Demographics
NPI:1003404245
Name:GRADY DENTAL CARE LLC
Entity Type:Organization
Organization Name:GRADY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-957-0770
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1998
Mailing Address - Country:US
Mailing Address - Phone:678-957-0770
Mailing Address - Fax:
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1998
Practice Address - Country:US
Practice Address - Phone:678-957-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental