Healthcare Provider Details

I. General information

NPI: 1437321296
Provider Name (Legal Business Name): BRADY J. SEMMEL, DMD, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 COMMONWEALTH DRIVE
WILMINGTON NC
28403-0302
US

IV. Provider business mailing address

1422 COMMONWEALTH DRIVE
WILMINGTON NC
28403-0302
US

V. Phone/Fax

Practice location:
  • Phone: 910-509-1422
  • Fax: 910-509-1421
Mailing address:
  • Phone: 910-509-1422
  • Fax: 910-509-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number200101495
License Number StateNC

VIII. Authorized Official

Name: BRADY JAMES SEMMEL
Title or Position: PRESIDENT
Credential: DMD, MD
Phone: 910-509-1422