Provider Demographics
NPI:1053497230
Name:BRADY, PAMELA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:BRADY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:NC
Mailing Address - Zip Code:28789-0148
Mailing Address - Country:US
Mailing Address - Phone:828-497-6707
Mailing Address - Fax:828-497-6709
Practice Address - Street 1:531 US HWY 441 N
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:NC
Practice Address - Zip Code:28789-0148
Practice Address - Country:US
Practice Address - Phone:828-497-6707
Practice Address - Fax:828-497-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902143Medicaid
NC9024EMedicare UPIN
NC5902143Medicaid