Provider Demographics
NPI:1922154335
Name:JUDY, BRAD N (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:N
Last Name:JUDY
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 1:8980 SE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5143
Mailing Address - Country:US
Mailing Address - Phone:206-612-3282
Mailing Address - Fax:
Practice Address - Street 1:3236 78TH AVE SE STE 106
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3500
Practice Address - Country:US
Practice Address - Phone:206-232-5866
Practice Address - Fax:206-232-5870
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60067325122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA 60067325OtherSTATE DENTAL LICENSE
WAWA 60067325OtherSTATE DENTAL LICENSE
WAWA 60067325OtherSTATE DENTAL LICENSE