Provider Demographics
NPI:1740022342
Name:GERBER, BRADY JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:JOHN
Last Name:GERBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1420
Mailing Address - Country:US
Mailing Address - Phone:262-248-2773
Mailing Address - Fax:
Practice Address - Street 1:580 BROAD ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1420
Practice Address - Country:US
Practice Address - Phone:262-248-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001569151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice