Individual
DR. PAUL W O'GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
4027 LAKE DR SE, SUITE 130, GRAND RAPIDS, MI 49546-8812
(616) 949-2100
(616) 949-8239
Mailing address
4027 LAKE DR SE, SUITE 130, GRAND RAPIDS, MI 49546-8812
(616) 949-2100
(616) 949-8239
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
017847
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4899515
—
MI
Enumeration date
10/25/2006
Last updated
01/07/2009
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