Provider Demographics
NPI:1265846190
Name:GRADINGER, BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:GRADINGER
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 1:23838 VALENCIA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5335
Mailing Address - Country:US
Mailing Address - Phone:661-450-6650
Mailing Address - Fax:
Practice Address - Street 1:23838 VALENCIA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5335
Practice Address - Country:US
Practice Address - Phone:661-450-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist