Provider Demographics
NPI:1639346877
Name:ERRON S BRADY DMD PA
Entity Type:Organization
Organization Name:ERRON S BRADY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERRON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-321-0414
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:28277-8009
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:28277-8009
Practice Address - Country:US
Practice Address - Phone:704-321-0414
Practice Address - Fax:704-321-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74111223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902HRMedicaid