Healthcare Provider Details

I. General information

NPI: 1144229709
Provider Name (Legal Business Name): EARL BRADEN GARD IV D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRADY GARD D.D.S.

II. Dates (important events)

Enumeration Date: 07/17/2005
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475-750 RICE CANYON RD.
SUSANVILLE CA
96130
US

IV. Provider business mailing address

65 N LASSEN ST UNIT 961
SUSANVILLE CA
96130-2437
US

V. Phone/Fax

Practice location:
  • Phone: 530-250-6944
  • Fax:
Mailing address:
  • Phone: 702-575-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5523
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100872
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5736
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: