Provider Demographics
NPI:1326114349
Name:BRADY, ERNEST A JR
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:A
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NO BROAD ST SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601
Mailing Address - Country:US
Mailing Address - Phone:352-796-2732
Mailing Address - Fax:352-754-1765
Practice Address - Street 1:120 NO BROAD ST SUITE 102
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-796-2732
Practice Address - Fax:352-754-1765
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00055331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice