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General NPI Number Information
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NPI Number | 1396173704
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Entity Type | Organization
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Legal Business Name | BRADLEY S. MOTT, DDS, PLLC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 01/01/2014
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Provider Practice Location Address
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Address Line | 6507 NE 181ST ST
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City | KENMORE
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State | WA
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Zip | 98028-4801
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Country | US
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Telephone | 425-486-9211
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Fax | 425-402-1093
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Provider Business Mailing Address
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Address Line | 6507 NE 181ST ST
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City | KENMORE
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State | WA
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Zip | 98028-4801
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Country | US
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Telephone | 425-486-9211
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Fax | 425-402-1093
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Authorized Official
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Title or Position | MEMBER, MANAGER
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Name | DR. BRADLEY S MOTT
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Credential | DDS
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Telephone | 763-227-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60091370
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License Number State | WA
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