Provider Demographics
NPI:1093886772
Name:MCGRADY, WILLIAM D (DMD)
Entity Type:Individual
Prefix:MISS
First Name:WILLIAM
Middle Name:D
Last Name:MCGRADY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12734 KENWOOD LN STE 66
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5638
Mailing Address - Country:US
Mailing Address - Phone:239-936-4727
Mailing Address - Fax:239-936-4193
Practice Address - Street 1:12734 KENWOOD LN STE 66
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5638
Practice Address - Country:US
Practice Address - Phone:239-926-4727
Practice Address - Fax:239-936-4193
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN126331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12633OtherDENTAL LICENSE