Provider Demographics
NPI:1023728391
Name:FRADY, BRILEY STULTS (RDH, RDA)
Entity type:Individual
Prefix:
First Name:BRILEY
Middle Name:STULTS
Last Name:FRADY
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-5431
Mailing Address - Country:US
Mailing Address - Phone:423-619-6649
Mailing Address - Fax:
Practice Address - Street 1:1272 MARKET ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1250
Practice Address - Country:US
Practice Address - Phone:423-834-9900
Practice Address - Fax:423-834-9901
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9376124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist