Individual
GRADY S RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1179 E PARIS AVE SE, GRAND RAPIDS, MI 49546-8371
(616) 942-9840
Mailing address
1179 E PARIS AVE SE STE 130, GRAND RAPIDS, MI 49546-3682
(616) 942-9840
(616) 942-0170
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901022570
MI
1223P0221X
Pediatric Dentistry
DEN.00201849
CO
Other
Enumeration date
07/08/2010
Last updated
03/28/2019
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