Healthcare Provider Details

I. General information

NPI: 1417574856
Provider Name (Legal Business Name): BRADLEY ADAMS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MAIN ST
WALPOLE MA
02081-1729
US

IV. Provider business mailing address

202 STANFORD DR
WESTWOOD MA
02090-3320
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-8008
  • Fax:
Mailing address:
  • Phone: 781-492-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858755
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: