Individual
ANN MARIE GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1360 E SPRUCE AVE STE 103, FRESNO, CA 93720-3378
(559) 860-2500
(559) 860-2502
Mailing address
1360 E SPRUCE AVE STE 103, FRESNO, CA 93720-3378
(559) 860-2500
(559) 860-2502
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
53741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53741
D.D.S.
CA
Enumeration date
10/24/2006
Last updated
06/14/2023
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