Provider Demographics
NPI:1508935115
Name:MCDONALD, BRADY CLARKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:CLARKE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 HARRISON AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5494
Mailing Address - Country:US
Mailing Address - Phone:360-352-4008
Mailing Address - Fax:360-534-0479
Practice Address - Street 1:1205 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5494
Practice Address - Country:US
Practice Address - Phone:360-352-4008
Practice Address - Fax:360-534-0479
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist