Provider Demographics
NPI:1346812831
Name:BRADY, MADALYN JOAN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:JOAN
Last Name:BRADY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:JOAN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1212 YALE PL APT C
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1911
Mailing Address - Country:US
Mailing Address - Phone:952-270-7982
Mailing Address - Fax:
Practice Address - Street 1:636 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2151
Practice Address - Country:US
Practice Address - Phone:612-746-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH11069124Q00000X
MNDT141125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist