=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437321296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRADY J. SEMMEL, DMD, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 08/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1422 COMMONWEALTH DRIVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28403-0302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-509-1422
-----------------------------------------------------
Fax | 910-509-1421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1422 COMMONWEALTH DRIVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28403-0302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-509-1422
-----------------------------------------------------
Fax | 910-509-1421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRADY JAMES SEMMEL
-----------------------------------------------------
Credential | DMD, MD
-----------------------------------------------------
Telephone | 910-509-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 200101495
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------