Provider Demographics
NPI:1407079338
Name:BRADY, PATRICK R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:BRADY
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:2630 S CARRIER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5069
Mailing Address - Country:US
Mailing Address - Phone:972-660-5522
Mailing Address - Fax:972-660-5525
Practice Address - Street 1:2630 S CARRIER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5069
Practice Address - Country:US
Practice Address - Phone:972-660-5522
Practice Address - Fax:972-660-5525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX86421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics