MEDICARE: BRADY DENTAL GROUP OF TAMPA BAY PA

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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1801730445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADY DENTAL GROUP OF TAMPA BAY PA

Provider Business Mailing Address
First Line	:	PO BOX 50006
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76206-0006
Country	:	US
Telephone Number	:	844-409-4657
Fax Number	:	214-614-4277

Provider Business Practice Location Address
First Line	:	26907 FOGGY CREEK RD STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	844-409-4657
Fax Number	:	214-614-4277

Authorized Official
Title or Position	:	DENTAL DIRECTOR
Name	:	DR. ANGIE NAUMAN
Credential	:	DDS
Telephone Number	:	844-409-4657

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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