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General NPI Number Information
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NPI Number | 1548513708
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Entity Type | Individual
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Provider Name | BRADY N MAXFIELD DDS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 2797 N HIGHWAY 89 #200
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-1216
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Country | US
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Telephone | 801-782-5682
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Fax |
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Provider Business Mailing Address
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Address Line | 9757 S CANDLEWOOD CIR
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City | SANDY
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State | UT
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Zip | 84092-3281
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Country | US
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Telephone | 801-808-2605
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Fax | 801-752-1466
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9371431-9921
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License Number State | UT
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