Provider Demographics
NPI:1407906977
Name:BRADY, MICHAEL W
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BRADY
Suffix:
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 1:4330 W BROWARD BLVD
Mailing Address - Street 2:SUIT T
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3775
Mailing Address - Country:US
Mailing Address - Phone:954-587-1800
Mailing Address - Fax:954-587-6267
Practice Address - Street 1:4330 W BROWARD BLVD
Practice Address - Street 2:SUIT T
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3775
Practice Address - Country:US
Practice Address - Phone:954-587-1800
Practice Address - Fax:954-587-6267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 142631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice