Provider Demographics
NPI:1336330265
Name:BRADY, KELLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1824
Mailing Address - Country:US
Mailing Address - Phone:203-329-2033
Mailing Address - Fax:203-329-1256
Practice Address - Street 1:1081 HOPE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-1824
Practice Address - Country:US
Practice Address - Phone:203-329-2033
Practice Address - Fax:203-329-1256
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist