Provider Demographics
NPI:1053041939
Name:MCGRATH, MELANIE (DMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4433
Mailing Address - Country:US
Mailing Address - Phone:317-701-2477
Mailing Address - Fax:
Practice Address - Street 1:916 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3702
Practice Address - Country:US
Practice Address - Phone:815-863-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist