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General NPI Number Information
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NPI Number | 1770750366
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Entity Type | Individual
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Provider Name | CHRISTOPHER GORDON BRADY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE SUITE #301
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City | ATLANTA
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State | GA
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Zip | 30342-1703
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Country | US
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Telephone | 404-255-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 3958 E BROOKHAVEN DR NE
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City | ATLANTA
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State | GA
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Zip | 30319-2808
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Country | US
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Telephone | 404-668-3332
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013759
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN013759
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License Number State | GA
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