MEDICARE: BRADY CHRISTENSON FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry	6065	VA

General Provider Information

NPI Number	:	1689893158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADY CHRISTENSON FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	4701 COLUMBUS ST
Second Line	:	SUITE 105
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6725
Country	:	US
Telephone Number	:	757-473-5706
Fax Number	:	757-476-5792

Provider Business Practice Location Address
First Line	:	4701 COLUMBUS ST
Second Line	:	SUITE 105
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6725
Country	:	US
Telephone Number	:	757-473-5706
Fax Number	:	757-476-5792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY J. BRADY
Credential	:	D.D.S.
Telephone Number	:	757-473-5706

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	02/19/2008

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