Provider Demographics
NPI:1417565144
Name:GEORGE, BRADY B (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:B
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PAVILION WAY STE G
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4560
Mailing Address - Country:US
Mailing Address - Phone:910-684-3687
Mailing Address - Fax:910-401-1918
Practice Address - Street 1:100 PAVILION WAY STE G
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4560
Practice Address - Country:US
Practice Address - Phone:910-684-3687
Practice Address - Fax:910-401-1918
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice