Provider Demographics
NPI:1023382546
Name:BRADY DENTAL GROUP
Entity Type:Organization
Organization Name:BRADY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-353-6422
Mailing Address - Street 1:2915 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3436
Mailing Address - Country:US
Mailing Address - Phone:806-353-6422
Mailing Address - Fax:806-352-0906
Practice Address - Street 1:2915 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3436
Practice Address - Country:US
Practice Address - Phone:806-353-6422
Practice Address - Fax:806-352-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty