Provider Demographics
NPI:1831213164
Name:GRADKE, GARY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:GRADKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6945 E SAHUARO DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6722
Mailing Address - Country:US
Mailing Address - Phone:480-998-7500
Mailing Address - Fax:480-998-7889
Practice Address - Street 1:6945 E SAHUARO DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6722
Practice Address - Country:US
Practice Address - Phone:480-998-7500
Practice Address - Fax:480-998-7889
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery