=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316379886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADY ROBLES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2013
-----------------------------------------------------
Last Update Date | 06/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2727 BUENA VISTA DR STE 110
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-8581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-238-1118
-----------------------------------------------------
Fax | 805-369-2055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 BUENA VISTA DR STE 110
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-8581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-238-1118
-----------------------------------------------------
Fax | 805-369-2055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6548
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------