Provider Demographics
NPI:1245602168
Name:ROBERT F. GRADISHAR DDS PA
Entity type:Organization
Organization Name:ROBERT F. GRADISHAR DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PREIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GRADISHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-725-3455
Mailing Address - Street 1:11200 SCAGGSVILLE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2024
Mailing Address - Country:US
Mailing Address - Phone:301-725-3455
Mailing Address - Fax:301-725-3004
Practice Address - Street 1:11200 SCAGGSVILLE RD STE 119
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2024
Practice Address - Country:US
Practice Address - Phone:301-725-3455
Practice Address - Fax:301-725-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty