Provider Demographics
NPI:1437321296
Name:BRADY J. SEMMEL, DMD, MD, PA
Entity Type:Organization
Organization Name:BRADY J. SEMMEL, DMD, MD, PA
Other - Org Name:SEMMEL ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:910-509-1422
Mailing Address - Street 1:1422 COMMONWEALTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0302
Mailing Address - Country:US
Mailing Address - Phone:910-509-1422
Mailing Address - Fax:910-509-1421
Practice Address - Street 1:1422 COMMONWEALTH DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0302
Practice Address - Country:US
Practice Address - Phone:910-509-1422
Practice Address - Fax:910-509-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001014951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131F4OtherBCBS
NC1406457OtherUCCI
NC89902FTMedicaid
NC10390209OtherVOCATIONAL REHABILITATION
NC89131F4Medicaid
NC145236OtherGUARDIAN
NC10390209OtherVOCATIONAL REHABILITATION
NC89131F4Medicaid
2003320Medicare PIN