Provider Demographics
NPI:1841553120
Name:BRADY, JASON WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WAYNE
Last Name:BRADY
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 1:3967 E LEAH CT
Mailing Address - Street 2:APT 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0019
Mailing Address - Country:US
Mailing Address - Phone:858-752-4622
Mailing Address - Fax:866-329-8262
Practice Address - Street 1:3967 E LEAH CT
Practice Address - Street 2:APT 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-0019
Practice Address - Country:US
Practice Address - Phone:858-752-4622
Practice Address - Fax:866-329-8262
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008375122300000X, 1223D0004X
CA609441223D0004X
TX305991223D0004X
MS3827-151223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist