Provider Demographics
NPI:1902968183
Name:BRADY, DENNIS JOHN SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:BRADY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 N HWY 47
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-3238
Mailing Address - Country:US
Mailing Address - Phone:636-456-8663
Mailing Address - Fax:636-456-6360
Practice Address - Street 1:2433 N HWY 47
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-3238
Practice Address - Country:US
Practice Address - Phone:636-456-8663
Practice Address - Fax:636-456-6360
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0112711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics