Provider Demographics
NPI:1427398478
Name:OKUDA, BRADY C (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:C
Last Name:OKUDA
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GREEN VALLEY PARKWAY
Mailing Address - Street 2:BLDG.#1
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-737-5500
Mailing Address - Fax:702-737-5565
Practice Address - Street 1:1701 N GREEN VALLEY PARKWAY
Practice Address - Street 2:BLDG.#1
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-737-5500
Practice Address - Fax:702-737-5565
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64431223X0400X
NVS3-3501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250016704Medicaid