Provider Demographics
NPI:1750497848
Name:BRADLEY J BEMIS PS
Entity Type:Organization
Organization Name:BRADLEY J BEMIS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEMIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-485-8292
Mailing Address - Street 1:18323 98TH AVE NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3358
Mailing Address - Country:US
Mailing Address - Phone:425-485-8292
Mailing Address - Fax:425-485-5732
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:SUITE 4
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:425-485-8292
Practice Address - Fax:425-485-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty