Healthcare Provider Details

I. General information

NPI: 1568918837
Provider Name (Legal Business Name): BRADLEY PHARES DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N 10TH ST STE 230
KALAMAZOO MI
49009-6150
US

IV. Provider business mailing address

1040 N 10TH ST STE 230
KALAMAZOO MI
49009-6150
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-6333
  • Fax:
Mailing address:
  • Phone: 269-372-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901602855
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: