Provider Demographics
NPI:1316028384
Name:BRADY, LELAND DAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:DAN
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 1:255 N ADAMS
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536
Mailing Address - Country:US
Mailing Address - Phone:417-588-2289
Mailing Address - Fax:417-588-4398
Practice Address - Street 1:255 N ADAMS
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536
Practice Address - Country:US
Practice Address - Phone:417-588-2289
Practice Address - Fax:417-588-4398
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice