MEDICARE: DR. BRAD N JUDY 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	122300000X	Dentist	DE60067325	WA
2	1223G0001X	General Practice Dentistry	DE60067325	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WA 60067325	OTHER	WA	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1922154335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD N JUDY DDS

Provider Business Mailing Address
First Line	:	8980 SE 54TH ST
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-5143
Country	:	US
Telephone Number	:	206-612-3282
Fax Number	:

Provider Business Practice Location Address
First Line	:	3236 78TH AVE SE STE 106
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3500
Country	:	US
Telephone Number	:	206-232-5866
Fax Number	:	206-232-5870

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	12/27/2023

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