Provider Demographics
NPI:1689893158
Name:BRADY CHRISTENSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BRADY CHRISTENSON FAMILY DENTISTRY
Other - Org Name:TOWN CENTER FAMILY DENTISY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-473-5706
Mailing Address - Street 1:4701 COLUMBUS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6725
Mailing Address - Country:US
Mailing Address - Phone:757-473-5706
Mailing Address - Fax:757-476-5792
Practice Address - Street 1:4701 COLUMBUS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6725
Practice Address - Country:US
Practice Address - Phone:757-473-5706
Practice Address - Fax:757-476-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA60651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty