MEDICARE: DR. ERRON A BRADY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7411	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518935287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERRON A BRADY DMD

Provider Business Mailing Address
First Line	:	11030 GOLF LINKS DR
Second Line	:	SUITE 201
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8007
Country	:	US
Telephone Number	:	704-321-0414
Fax Number	:	704-321-0217

Provider Business Practice Location Address
First Line	:	11030 GOLF LINKS DR
Second Line	:	SUITE 201
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8007
Country	:	US
Telephone Number	:	704-321-0414
Fax Number	:	704-321-0217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/09/2007

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