Provider Demographics
NPI:1356525646
Name:GRADY, SEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:GRADY
Suffix:
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20142-0606
Mailing Address - Country:US
Mailing Address - Phone:703-431-6918
Mailing Address - Fax:
Practice Address - Street 1:2 WEST LOUDOUN STREET
Practice Address - Street 2:
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20142-0606
Practice Address - Country:US
Practice Address - Phone:703-431-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice