Individual
DR. JOHN ROBERT GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
522 WATER ST, SAUK CITY, WI 53583-1141
(608) 643-4441
Mailing address
918 OAK ST, BARABOO, WI 53913-2168
(608) 356-9595
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
53000902
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3360270
BADGERCARE
WI
Enumeration date
07/18/2007
Last updated
07/27/2007
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