Provider Demographics
NPI:1730499476
Name:GRADY, KATHERINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:GRADY
Suffix:
Gender:F
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:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1305
Mailing Address - Country:US
Mailing Address - Phone:352-589-6424
Mailing Address - Fax:352-589-6492
Practice Address - Street 1:875 OAKLEY SEAVER DRIVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-989-9001
Practice Address - Fax:352-360-6674
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist