Provider Demographics
NPI:1649490335
Name:HAGEL-BRADWAY, SUSAN E (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:HAGEL-BRADWAY
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2412
Mailing Address - Country:US
Mailing Address - Phone:253-272-3561
Mailing Address - Fax:
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:C21
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-759-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000072431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics