Provider Demographics
NPI:1548316391
Name:MCGRADY, JODI A (DMD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:A
Last Name:MCGRADY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PASEO DE PERALTA
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-983-2909
Mailing Address - Fax:505-986-8005
Practice Address - Street 1:141 PASEO DE PERALTA
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2914
Practice Address - Country:US
Practice Address - Phone:505-983-2909
Practice Address - Fax:505-986-8005
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice