Provider Demographics
NPI:1295744407
Name:GRADY, SEAN P (DDS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:GRADY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1503
Mailing Address - Country:US
Mailing Address - Phone:678-957-0770
Mailing Address - Fax:678-957-0778
Practice Address - Street 1:10900 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1503
Practice Address - Country:US
Practice Address - Phone:678-957-0770
Practice Address - Fax:678-957-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0120521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice