Individual
DR. JACK GRADOVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
827 S HIGHLAND ST, WILLIAMSBURG, IA 52361-9333
(319) 668-9808
Mailing address
720 GREENWOOD DR, IOWA CITY, IA 52246-2124
(515) 664-0180
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DDS-10008
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS-10008
DENTAL LICENSE NUMBER
IA
Enumeration date
06/20/2022
Last updated
06/20/2022
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