Provider Demographics
NPI:1952399461
Name:SEMMEL, BRADY JAMES (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:JAMES
Last Name:SEMMEL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0302
Mailing Address - Country:US
Mailing Address - Phone:910-509-1422
Mailing Address - Fax:910-509-1421
Practice Address - Street 1:1422 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0302
Practice Address - Country:US
Practice Address - Phone:910-509-1422
Practice Address - Fax:910-509-1421
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001014951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131F4OtherBLUE CROSS BLUE SHIELD
NC10390209OtherVOCATIONAL REHABILITATION
NC89902FTMedicaid
NC89131F4Medicaid
2003320Medicare ID - Type Unspecified
NC89902FTMedicaid