Healthcare Provider Details

I. General information

NPI: 1346369501
Provider Name (Legal Business Name): BRADLEY ALLAN TRATTNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RESERVOIR CIR #102
BALTIMORE MD
21208-6324
US

IV. Provider business mailing address

8 RESERVOIR CIR #102
BALTIMORE MD
21208-6324
US

V. Phone/Fax

Practice location:
  • Phone: 410-653-2020
  • Fax: 410-486-6617
Mailing address:
  • Phone: 410-653-2020
  • Fax: 410-486-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: