MEDICARE: BRADLEY JON PULFER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12010676A	IN

General Provider Information

NPI Number	:	1851571301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JON PULFER D.D.S.

Provider Business Mailing Address
First Line	:	1405 MEDICAL PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5831
Country	:	US
Telephone Number	:	260-482-4483
Fax Number	:	260-471-9889

Provider Business Practice Location Address
First Line	:	1405 MEDICAL PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5831
Country	:	US
Telephone Number	:	260-482-4483
Fax Number	:	260-471-9889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	07/08/2008

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