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General NPI Number Information
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NPI Number | 1689893158
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Entity Type | Organization
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Legal Business Name | BRADY CHRISTENSON FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 4701 COLUMBUS ST SUITE 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6725
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Country | US
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Telephone | 757-473-5706
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Fax | 757-476-5792
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Provider Business Mailing Address
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Address Line | 4701 COLUMBUS ST SUITE 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6725
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Country | US
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Telephone | 757-473-5706
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Fax | 757-476-5792
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY J. BRADY
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Credential | D.D.S.
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Telephone | 757-473-5706
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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 | 6065
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License Number State | VA
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