Provider Demographics
NPI:1245701465
Name:BRADY, JEFFREY LEVITT (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEVITT
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 1:10060 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2334
Mailing Address - Country:US
Mailing Address - Phone:503-228-4988
Mailing Address - Fax:503-228-6245
Practice Address - Street 1:10060 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2334
Practice Address - Country:US
Practice Address - Phone:503-228-4988
Practice Address - Fax:503-228-6245
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203231223G0001X
ORD43111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice