Organization
JERRY D GRAGG DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA MCDERMOTT (OFFICE MANAGER)
(414) 445-4111
Entity
Organization
Contact information
Practice address
3489 N 76TH ST, MILWAUKEE, WI 53222-3968
(414) 445-4111
(414) 445-4103
Mailing address
3489 N 76TH ST, MILWAUKEE, WI 53222-3968
(414) 445-4111
(414) 445-4103
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2473
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33408000
—
WI
Enumeration date
08/17/2010
Last updated
08/17/2010
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