Provider Demographics
NPI:1184713893
Name:BRADY, ERIN S (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:S
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 1:1438 E. AUGUSTINE LN
Mailing Address - Street 2:STE #1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-251-9000
Mailing Address - Fax:479-251-9002
Practice Address - Street 1:1438 E. AUGUSTINE LN
Practice Address - Street 2:STE #1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-251-9000
Practice Address - Fax:479-251-9002
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1620894OtherUCCI
AR5X950OtherBC/BS