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General NPI Number Information
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NPI Number | 1770399230
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Entity Type | Individual
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Provider Name | KRISTINE BRADY
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 352 THOMPSON CREEK MALL
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2500
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Country | US
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Telephone | 410-934-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 24019 CHESTERTOWN RD
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City | CHESTERTOWN
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State | MD
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Zip | 21620-3920
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Country | US
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Telephone | 443-336-0847
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6969
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License Number State | MD
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