Provider Demographics
NPI:1558577221
Name:DONATHAN, GRADY DAVID III (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:DAVID
Last Name:DONATHAN
Suffix:III
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 1:519 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5819
Mailing Address - Country:US
Mailing Address - Phone:918-423-2575
Mailing Address - Fax:918-423-7265
Practice Address - Street 1:519 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5819
Practice Address - Country:US
Practice Address - Phone:918-423-2575
Practice Address - Fax:918-423-7265
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist