Provider Demographics
NPI:1194571869
Name:R BRADY PERDUE DDS, PLLC
Entity type:Organization
Organization Name:R BRADY PERDUE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-604-5257
Mailing Address - Street 1:2110 E MURRAY HOLLADAY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5598
Mailing Address - Country:US
Mailing Address - Phone:801-277-1916
Mailing Address - Fax:
Practice Address - Street 1:2110 E MURRAY HOLLADAY RD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5598
Practice Address - Country:US
Practice Address - Phone:801-277-1916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty