Organization
ANN MARIE GRADY, D.D.S., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN MARIE GRADY D.D.S. (OWNER)
(559) 435-7993
Entity
Organization
Contact information
Practice address
1313 E HERNDON AVE STE 104, FRESNO, CA 93720-3306
(559) 435-7993
(559) 435-7935
Mailing address
1313 E. HERNDON AVE. #104, FRESNO, CA 93720
(559) 435-7993
(559) 435-7935
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
53741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53741
DENTAL LICENSE
CA
Enumeration date
01/04/2007
Last updated
11/29/2007
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