Provider Demographics
NPI:1720576671
Name:JODI A MCGRADY DMD, MS, ADC
Entity Type:Organization
Organization Name:JODI A MCGRADY DMD, MS, ADC
Other - Org Name:MCGRADY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-748-3090
Mailing Address - Street 1:12350 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5320
Mailing Address - Country:US
Mailing Address - Phone:858-748-3090
Mailing Address - Fax:
Practice Address - Street 1:12350 OAK KNOLL RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-748-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548316391OtherINDIVIDUAL NPI