Provider Demographics
NPI:1376725499
Name:BRADY, DANIEL THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:BRADY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11705 WILMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-6012
Mailing Address - Country:US
Mailing Address - Phone:425-953-6476
Mailing Address - Fax:360-659-1275
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-658-8822
Practice Address - Fax:360-659-1275
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE 602143911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery