Provider Demographics
NPI:1679653315
Name:BRADY, TAMARA SUE (DMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:SUE
Last Name:BRADY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:SUE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:293 WATCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2192
Mailing Address - Country:US
Mailing Address - Phone:610-280-6835
Mailing Address - Fax:610-280-9652
Practice Address - Street 1:155 LITTLE CONESTOGA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1847
Practice Address - Country:US
Practice Address - Phone:610-458-8025
Practice Address - Fax:610-458-3940
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028473L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice