Provider Demographics
NPI:1033746136
Name:JILLIAN C. BRADY, DDS, LLC
Entity Type:Organization
Organization Name:JILLIAN C. BRADY, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-889-6000
Mailing Address - Street 1:5150 E STOP 11 RD STE 11
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8629
Mailing Address - Country:US
Mailing Address - Phone:317-889-6000
Mailing Address - Fax:
Practice Address - Street 1:5150 E STOP 11 RD STE 11
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8629
Practice Address - Country:US
Practice Address - Phone:317-889-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental