Provider Demographics
NPI:1235277146
Name:KATHRYN L. GRADY DDS, PC
Entity Type:Organization
Organization Name:KATHRYN L. GRADY DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-789-3803
Mailing Address - Street 1:700 E OGDEN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5554
Mailing Address - Country:US
Mailing Address - Phone:630-789-3903
Mailing Address - Fax:
Practice Address - Street 1:700 E OGDEN AVE STE 302
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5554
Practice Address - Country:US
Practice Address - Phone:630-789-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty