Healthcare Provider Details

I. General information

NPI: 1083535413
Provider Name (Legal Business Name): CORBEN BRADLY MASTERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 S 324TH PL
FEDERAL WAY WA
98003-8505
US

IV. Provider business mailing address

1917 HILLSIDE DR NE
TACOMA WA
98422-4281
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-1225
  • Fax:
Mailing address:
  • Phone: 253-227-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70138686
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: