Provider Demographics
NPI:1902494008
Name:GRADY DENTAL CARE , LLC
Entity Type:Organization
Organization Name:GRADY DENTAL CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DDS
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-822-0288
Mailing Address - Street 1:935 BUFORD RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3221
Mailing Address - Country:US
Mailing Address - Phone:678-822-0288
Mailing Address - Fax:
Practice Address - Street 1:935 BUFORD RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3221
Practice Address - Country:US
Practice Address - Phone:678-822-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental