Provider Demographics
NPI:1851666416
Name:BRADY, MATTHEW BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BENJAMIN
Last Name:BRADY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 ASHTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-1812
Mailing Address - Country:US
Mailing Address - Phone:337-380-8485
Mailing Address - Fax:
Practice Address - Street 1:1050 E ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6711
Practice Address - Country:US
Practice Address - Phone:337-446-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice