Provider Demographics
NPI:1033784897
Name:GRADY-WILLIAMS, DIAMOND (DMD)
Entity type:Individual
Prefix:DR
First Name:DIAMOND
Middle Name:
Last Name:GRADY-WILLIAMS
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 1:7020 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1649
Mailing Address - Country:US
Mailing Address - Phone:708-794-9526
Mailing Address - Fax:
Practice Address - Street 1:7020 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1649
Practice Address - Country:US
Practice Address - Phone:708-794-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190335471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry