Provider Demographics
NPI:1831747799
Name:BRADY DENTAL GROUP, PA
Entity type:Organization
Organization Name:BRADY DENTAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-597-7441
Mailing Address - Street 1:702 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-6936
Mailing Address - Country:US
Mailing Address - Phone:325-597-7441
Mailing Address - Fax:
Practice Address - Street 1:702 W 17TH ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-6936
Practice Address - Country:US
Practice Address - Phone:325-597-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADY DENTAL GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies