MEDICARE: MR. DENNIS JOHN BRADY JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	016080	MO

General Provider Information

NPI Number	:	1598160053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS JOHN BRADY JR. D.D.S.

Provider Business Mailing Address
First Line	:	2433 N. HWY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-3238
Country	:	US
Telephone Number	:	636-456-8663
Fax Number	:	636-456-6360

Provider Business Practice Location Address
First Line	:	2433 N. HWY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-3238
Country	:	US
Telephone Number	:	636-456-8663
Fax Number	:	636-456-6360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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Directions to “ MR. DENNIS JOHN BRADY JR. D.D.S.” Practice Location

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