Provider Demographics
NPI:1659434645
Name:BRADY, CRYSTAL AM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:AM
Last Name:BRADY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4109
Mailing Address - Country:US
Mailing Address - Phone:281-332-7563
Mailing Address - Fax:281-332-0617
Practice Address - Street 1:521 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-332-7563
Practice Address - Fax:281-332-0617
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15127332B00000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies