Provider Demographics
NPI:1548513708
Name:MAXFIELD, BRADY N (DDS)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:N
Last Name:MAXFIELD
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 1:9757 S CANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3281
Mailing Address - Country:US
Mailing Address - Phone:801-808-2605
Mailing Address - Fax:801-752-1466
Practice Address - Street 1:2797 N HIGHWAY 89
Practice Address - Street 2:#200
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1216
Practice Address - Country:US
Practice Address - Phone:801-782-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9371431-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics