Provider Demographics
NPI:1154841161
Name:ATKINS, BRADY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:ROBERT
Last Name:ATKINS
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 1:4848 PIN OAK PARK APT 611
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2281
Mailing Address - Country:US
Mailing Address - Phone:979-224-3729
Mailing Address - Fax:
Practice Address - Street 1:1700 CRESCENT POINTE PKWY
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-3898
Practice Address - Country:US
Practice Address - Phone:979-846-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist