Provider Demographics
NPI:1467802736
Name:GRATHWOL, CORY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:A
Last Name:GRATHWOL
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 1:47 E CHICAGO AVE STE 344
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5360
Mailing Address - Country:US
Mailing Address - Phone:630-778-9500
Mailing Address - Fax:630-778-9521
Practice Address - Street 1:47 E CHICAGO AVE STE 344
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5360
Practice Address - Country:US
Practice Address - Phone:630-778-9500
Practice Address - Fax:630-778-9521
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
IL0190315671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program