Provider Demographics
NPI:1285626267
Name:GRADEN, DARRYL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:STEPHEN
Last Name:GRADEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7895 BROADWAY
Mailing Address - Street 2:SUITE K
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5529
Mailing Address - Country:US
Mailing Address - Phone:219-769-7151
Mailing Address - Fax:219-769-7156
Practice Address - Street 1:7895 BROADWAY
Practice Address - Street 2:SUITE K
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5529
Practice Address - Country:US
Practice Address - Phone:219-769-7151
Practice Address - Fax:219-769-7156
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120071521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice