MEDICARE: DR. COURTNEY LYNN BRADY D.M.D.

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	DN1855937	MA

General Provider Information

NPI Number	:	1780946582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY LYNN BRADY D.M.D.

Provider Business Mailing Address
First Line	:	171 ROCKLAND ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2222
Country	:	US
Telephone Number	:	781-826-8331
Fax Number	:	781-829-0747

Provider Business Practice Location Address
First Line	:	171 ROCKLAND ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2222
Country	:	US
Telephone Number	:	781-826-8331
Fax Number	:	781-829-0747

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

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	06/08/2012

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