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General NPI Number Information
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NPI Number | 1851666416
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Entity Type | Individual
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Provider Name | MATTHEW BENJAMIN BRADY DDS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 1050 E ADMIRAL DOYLE DR
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City | NEW IBERIA
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State | LA
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Zip | 70560-6711
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Country | US
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Telephone | 337-446-2373
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Fax |
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Provider Business Mailing Address
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Address Line | 626 ASHTON ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-1812
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Country | US
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Telephone | 337-380-8485
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6264
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License Number State | LA
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