Provider Demographics
NPI:1255746780
Name:BEMIS, BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:BEMIS
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 1:18323 98TH AVE NE
Mailing Address - Street 2:STE4
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:STE4
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
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist