Healthcare Provider Details

I. General information

NPI: 1902968183
Provider Name (Legal Business Name): DENNIS JOHN BRADY SR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 N HWY 47
WARRENTON MO
63383-3238
US

IV. Provider business mailing address

2433 N HWY 47
WARRENTON MO
63383-3238
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 Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number011271
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: