Provider Demographics
NPI:1518935287
Name:BRADY, ERRON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERRON
Middle Name:A
Last Name:BRADY
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 1:11030 GOLF LINKS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8007
Mailing Address - Country:US
Mailing Address - Phone:704-321-0414
Mailing Address - Fax:704-321-0217
Practice Address - Street 1:11030 GOLF LINKS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8007
Practice Address - Country:US
Practice Address - Phone:704-321-0414
Practice Address - Fax:704-321-0217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902HRMedicaid