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General NPI Number Information
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NPI Number | 1922154335
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Entity Type | Individual
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Provider Name | BRAD N JUDY DDS
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 3236 78TH AVE SE STE 106
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3500
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Country | US
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Telephone | 206-232-5866
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Fax | 206-232-5870
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Provider Business Mailing Address
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Address Line | 8980 SE 54TH ST
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City | MERCER ISLAND
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State | WA
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Zip | 98040-5143
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Country | US
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Telephone | 206-612-3282
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60067325
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60067325
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License Number State | WA
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