Healthcare Provider Details

I. General information

NPI: 1447611223
Provider Name (Legal Business Name): BRADLEY JOSEPH GAUTHIER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W UNIVERSITY DR STE 101
ROCHESTER MI
48307-1979
US

IV. Provider business mailing address

1000 W UNIVERSITY DR STE 101
ROCHESTER MI
48307-1979
US

V. Phone/Fax

Practice location:
  • Phone: 248-656-0040
  • Fax:
Mailing address:
  • Phone: 248-656-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901021816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: