Most Relevant Information
Provider Data
| NPI Number: | 1003346917 |
| Provider Name: | BRADY TODD PETERSEN DMD, MS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223X0400X |
| Specialty: | Dentist |
| License Number: | S3-366 |
Most Important Dates
| Enumeration Date: | 06/13/2017 |
| Last Updated: | 04/30/2024 |
Provider Practice Location
6425 S DURANGO DR STE 120
LAS VEGAS
NV
891137113
Practice Location Phone/Fax
| Phone: | 7027575355 |
| Fax: |
Provider Mailing Location
6425 S DURANGO DR STE 120
LAS VEGAS
NV
891137113
Provider Mailing Phone/Fax
| Phone: | 7027575355 |
| Fax: |