Provider Demographics
NPI:1235298035
Name:GRADY, ROBERT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:GRADY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:240 SPRING ST
Mailing Address - Street 2:#410
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4477
Mailing Address - Country:US
Mailing Address - Phone:651-353-6765
Mailing Address - Fax:
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:9-470C MOOS TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-626-5161
Practice Address - Fax:612-626-1496
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND108441223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics