MEDICARE: W BRADFORD HEPWORTH DDS MD MS PC

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1891081212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W BRADFORD HEPWORTH DDS MD MS PC

Provider Business Mailing Address
First Line	:	PO BOX 11680
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-5680
Country	:	US
Telephone Number	:	206-842-8135
Fax Number	:	206-842-2501

Provider Business Practice Location Address
First Line	:	380 ERICKSEN AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1854
Country	:	US
Telephone Number	:	206-842-8135
Fax Number	:	206-842-2501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM B HEPWORTH
Credential	:	MD, DDS, MS
Telephone Number	:	206-842-8135

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	07/22/2011

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