Provider Demographics
NPI:1265858211
Name:BRADY, CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
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 1:3940 TIMBER LANE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:719-495-9865
Mailing Address - Fax:719-466-9119
Practice Address - Street 1:3940 TIMBER LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3764
Practice Address - Country:US
Practice Address - Phone:719-495-9865
Practice Address - Fax:719-466-9119
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist