Provider Demographics
NPI:1437225133
Name:JOHN MARSHALL GRADY DMD & ASSOCIATES LLC
Entity Type:Organization
Organization Name:JOHN MARSHALL GRADY DMD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-9222
Mailing Address - Street 1:1000 BROOKTREE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-935-9222
Mailing Address - Fax:724-935-9241
Practice Address - Street 1:1000 BROOKTREE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090
Practice Address - Country:US
Practice Address - Phone:724-935-9222
Practice Address - Fax:724-935-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026079L1223X0400X
PADS028329L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty