# BRADY NIELSEN DDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710572581
- **Authorized official:** DR. BRADY NIELSEN DDS (PRESIDENT)
- **Authorized official phone:** (310) 883-5017

## Contact information

- **Practice address:** 675 CAMINO DE LOS MARES STE 303, SAN CLEMENTE, CA 92673-2837
- **Practice address phone:** (949) 627-0230
- **Practice address fax:** (949) 627-0370
- **Mailing address:** 675 CAMINO DE LOS MARES STE 303, SAN CLEMENTE, CA 92673-2837
- **Mailing address phone:** (949) 627-0230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/04/2021
- **Last updated:** 03/04/2021