Provider Demographics
NPI:1134357486
Name:MCGRADY, MICHAEL JOHN SR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MCGRADY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:900 W. RT 22
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3423
Mailing Address - Country:US
Mailing Address - Phone:847-438-9090
Mailing Address - Fax:847-540-8505
Practice Address - Street 1:900 W IL ROUTE 22
Practice Address - Street 2:SUITE 170
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3416
Practice Address - Country:US
Practice Address - Phone:847-438-9090
Practice Address - Fax:847-540-8505
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0013281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics