Organization
JOHN R GRADY DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT GRADY DDS (PRESIDENT)
(608) 356-9595
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33602700
—
WI
Enumeration date
06/22/2007
Last updated
07/27/2007
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