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General NPI Number Information
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NPI Number | 1710572581
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Entity Type | Organization
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Legal Business Name | BRADY NIELSEN DDS, INC.
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 675 CAMINO DE LOS MARES STE 303
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2837
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Country | US
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Telephone | 949-627-0230
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Fax | 949-627-0370
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Provider Business Mailing Address
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Address Line | 675 CAMINO DE LOS MARES STE 303
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2837
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Country | US
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Telephone | 949-627-0230
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADY NIELSEN
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Credential | DDS
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Telephone | 310-883-5017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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