Healthcare Provider Details

I. General information

NPI: 1477524643
Provider Name (Legal Business Name): MATTHEW BRADY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 ESTHER CIR
FREDERICK CO
80504-5881
US

IV. Provider business mailing address

2381 ANTELOPE RIDGE TRL
PARKER CO
80138-4235
US

V. Phone/Fax

Practice location:
  • Phone: 757-462-6602
  • Fax:
Mailing address:
  • Phone: 757-462-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8112
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00201885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: