Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE00005547 | WA |
NPI | 1053531772 |
---|---|
Provider Name | Dr. Steven D Bradway |
First Address | Tacoma, WA 98405-1300 |
Second Address | Tacoma, WA 98405-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |