Provider Demographics
NPI:1730398223
Name:BRADY, RAYMOND J (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:BRADY
Suffix:
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 1:2700 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1129
Mailing Address - Country:US
Mailing Address - Phone:562-420-1301
Mailing Address - Fax:
Practice Address - Street 1:2700 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1129
Practice Address - Country:US
Practice Address - Phone:562-420-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice