Provider Demographics
NPI:1164739884
Name:BRADY, MELISSA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
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 1:3245 SE CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6618
Mailing Address - Country:US
Mailing Address - Phone:503-653-8320
Mailing Address - Fax:
Practice Address - Street 1:3245 SE CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6618
Practice Address - Country:US
Practice Address - Phone:503-653-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 9486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist