Individual provider Active NPI

Daniel Thomas Brady, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
National Provider Identifier
1376725499
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DE 60214391 Issued in WA
Practice address
16410 Smokey Point Blvd
Suite 103
Arlington, WA 98223-8415
Phone
(360) 658-8822
Fax
(360) 659-1275
NPI assigned
Nov 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DE 60214391 WA Primary

Addresses

Primary practice location

16410 Smokey Point Blvd
Suite 103
Arlington, WA 98223-8415

Mailing address

11705 Wilmington Way
Mukilteo, WA 98275-6012
Phone (425) 953-6476

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective May 9, 2012 through May 9, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE 60214391WAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Kincaid, McClary & Kim D.D.S, P.S. Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1376725499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11705 WILMINGTON WAY",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982756012",
            "telephone_number": "425-953-6476",
            "fax_number": "360-659-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16410 SMOKEY POINT BLVD",
            "address_2": "SUITE 103",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238415",
            "telephone_number": "360-658-8822",
            "fax_number": "360-659-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY",
        "first_name": "DANIEL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-30",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE 60214391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, WA

Sources for this page

Verify at the official NPI Registry.