Healthcare Provider Details

I. General information

NPI: 1255016184
Provider Name (Legal Business Name): KAMERON BRADY REDDISH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AMERICANO BASE NAVAL DE ROTA APARTADO DE CORREOS 33
FPO AE
11530
US

IV. Provider business mailing address

PSC 819 BOX 18
FPO AE
09645-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-3733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: