MEDICARE: BRADY N MAXFIELD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9371431-9921	UT

General Provider Information

NPI Number	:	1548513708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADY N MAXFIELD DDS

Provider Business Mailing Address
First Line	:	9757 S CANDLEWOOD CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-3281
Country	:	US
Telephone Number	:	801-808-2605
Fax Number	:	801-752-1466

Provider Business Practice Location Address
First Line	:	2797 N HIGHWAY 89
Second Line	:	#200
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84404-1216
Country	:	US
Telephone Number	:	801-782-5682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	01/06/2017

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Directions to “ BRADY N MAXFIELD DDS” Practice Location

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