Provider Demographics
NPI:1891081212
Name:W BRADFORD HEPWORTH DDS MD MS PC
Entity Type:Organization
Organization Name:W BRADFORD HEPWORTH DDS MD MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEPWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS, MS
Authorized Official - Phone:206-842-8135
Mailing Address - Street 1:PO BOX 11680
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5680
Mailing Address - Country:US
Mailing Address - Phone:206-842-8135
Mailing Address - Fax:206-842-2501
Practice Address - Street 1:380 ERICKSEN AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1854
Practice Address - Country:US
Practice Address - Phone:206-842-8135
Practice Address - Fax:206-842-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB21289Medicare UPIN