MEDICARE: DR. DENNIS JOHN BRADY SR. DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	011271	MT

General Provider Information

NPI Number	:	1902968183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS JOHN BRADY SR. DDS

Provider Business Mailing Address
First Line	:	2433 N HWY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-3238
Country	:	US
Telephone Number	:	636-456-8663
Fax Number	:	636-456-6360

Provider Business Practice Location Address
First Line	:	2433 N HWY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-3238
Country	:	US
Telephone Number	:	636-456-8663
Fax Number	:	636-456-6360

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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