Healthcare Provider Details

I. General information

NPI: 1205904422
Provider Name (Legal Business Name): BRADY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 N HWY 47
WARRENTON MO
63383
US

IV. Provider business mailing address

2433 N HWY 47
WARRENTON MO
63383
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-8663
  • Fax: 636-456-6360
Mailing address:
  • Phone: 636-456-8663
  • Fax: 636-456-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016080
License Number StateMO

VIII. Authorized Official

Name: DR. DENNIS J BRADY JR.
Title or Position: OWNER
Credential: DDS
Phone: 636-456-8663