Provider Demographics
NPI:1811005879
Name:O'GRADY, DENNIS EVAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EVAN
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4223
Mailing Address - Country:US
Mailing Address - Phone:937-428-0724
Mailing Address - Fax:937-428-0824
Practice Address - Street 1:7085 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4223
Practice Address - Country:US
Practice Address - Phone:937-428-0724
Practice Address - Fax:937-428-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR73060Medicare UPIN
OH9352041Medicare UPIN