Provider Demographics
NPI:1548556459
Name:MEGAN JURECKO GRACY, DMD
Entity Type:Organization
Organization Name:MEGAN JURECKO GRACY, DMD
Other - Org Name:ASSOCIATED ENDODONTISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:JURECKO
Authorized Official - Last Name:GRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-332-3788
Mailing Address - Street 1:1204 NW 69TH TER
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3158
Mailing Address - Country:US
Mailing Address - Phone:352-332-3788
Mailing Address - Fax:352-332-3791
Practice Address - Street 1:1204 NW 69TH TER
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3158
Practice Address - Country:US
Practice Address - Phone:352-332-3788
Practice Address - Fax:352-332-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty