Provider Demographics
NPI:1336368828
Name:BRADY, GRACE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-0640
Mailing Address - Country:US
Mailing Address - Phone:972-736-3552
Mailing Address - Fax:972-736-6273
Practice Address - Street 1:112 N 4TH STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-0640
Practice Address - Country:US
Practice Address - Phone:972-736-3552
Practice Address - Fax:972-736-6273
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice