Provider Demographics
NPI:1053503805
Name:BRADY, RODNEY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:D
Last Name:BRADY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N LINDER RD STE G
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4392
Mailing Address - Country:US
Mailing Address - Phone:208-888-3384
Mailing Address - Fax:
Practice Address - Street 1:870 N LINDER RD STE G
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4392
Practice Address - Country:US
Practice Address - Phone:208-888-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-17951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice