Gradoville, Jack

Gradoville, Jack is an individual health care provider with primary practice located at 827 S Highland St , Williamsburg IA 52361-9333. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Gradoville, Jack can be contacted via phone (319) 668-9808.

Contact Information

Primary practice address
827 S Highland St Williamsburg IA 52361-9333
Phone: (319) 668-9808
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DDS-10008 Iowa

Profile Details

NPI number 1326779588
LBN Legal business name Gradoville, Jack
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2022
Last updated Jun 20th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326779588 NPPES
Iowa Other DDS-10008 DENTAL LICENSE NUMBER

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