Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D10844 | MN |
NPI | 1235298035 |
---|---|
Provider Name | Dr. Robert David Grady |
First Address | Saint Paul, MN 55102-4477 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 01/05/2015 |