MEDICARE: BRADLEY P BROWN DDS PS

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	1223E0200X	Endodontics	5156	WA

General Provider Information

NPI Number	:	1841336153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY P BROWN DDS PS

Provider Business Mailing Address
First Line	:	7409 W GRANDRIDGE BLVD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336
Country	:	US
Telephone Number	:	509-783-1335
Fax Number	:	509-783-1524

Provider Business Practice Location Address
First Line	:	7409 W GRANDRIDGE BLVD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336
Country	:	US
Telephone Number	:	509-783-1335
Fax Number	:	509-783-1524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRADLEY PAGE BROWN
Credential	:	DDS
Telephone Number	:	509-783-1335

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/22/2011

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