Healthcare Provider Details

I. General information

NPI: 1003955253
Provider Name (Legal Business Name): CHRISTOPHER DALE BRADLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD
BETHESDA MD
20889-2575
US

IV. Provider business mailing address

10 FLAMINGO CV
BEAUFORT SC
29907-1824
US

V. Phone/Fax

Practice location:
  • Phone: 252-515-2848
  • Fax:
Mailing address:
  • Phone: 252-515-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: