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General NPI Number Information
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NPI Number | 1679653315
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Entity Type | Individual
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Provider Name | TAMARA SUE BRADY DMD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 155 LITTLE CONESTOGA RD SUITE 2
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-1847
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Country | US
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Telephone | 610-458-8025
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Fax | 610-458-3940
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Provider Business Mailing Address
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Address Line | 293 WATCH HILL RD
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City | EXTON
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State | PA
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Zip | 19341-2192
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Country | US
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Telephone | 610-280-6835
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Fax | 610-280-9652
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS028473L
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License Number State | PA
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