Provider Demographics
NPI:1841859246
Name:ROBBINS, BRADY (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:
Last Name:ROBBINS
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 1:185 S 300 E
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1343
Mailing Address - Country:US
Mailing Address - Phone:208-540-2646
Mailing Address - Fax:
Practice Address - Street 1:185 S 300 E
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1343
Practice Address - Country:US
Practice Address - Phone:208-540-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist