Healthcare Provider Details

I. General information

NPI: 1003974239
Provider Name (Legal Business Name): BRADLEY NORFLEET STEARSMAN DMD PSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG C SUITE 102
OWENSBORO KY
42303
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG C STE 102
OWENSBORO KY
42303
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3199
  • Fax: 270-926-3636
Mailing address:
  • Phone: 270-926-3199
  • Fax: 270-926-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: