Provider Demographics
NPI:1407292824
Name:BRADY, TIFFANY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:BRADY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 NW 53RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4653
Mailing Address - Country:US
Mailing Address - Phone:954-417-1337
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:ROCKLAND HALL, ROOM 114
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8701
Practice Address - Country:US
Practice Address - Phone:631-632-3181
Practice Address - Fax:631-632-8717
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN214591223P0221X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program