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General NPI Number Information
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NPI Number | 1841553120
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Entity Type | Individual
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Provider Name | JASON WAYNE BRADY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 3967 E LEAH CT APT 101
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City | GILBERT
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State | AZ
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Zip | 85234-0019
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Country | US
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Telephone | 858-752-4622
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Fax | 866-329-8262
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Provider Business Mailing Address
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Address Line | 3967 E LEAH CT APT 101
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City | GILBERT
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State | AZ
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Zip | 85234-0019
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Country | US
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Telephone | 858-752-4622
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Fax | 866-329-8262
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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 | D008375
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | D008375
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 60944
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 30599
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 3827-15
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License Number State | MS
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