Healthcare Provider Details

I. General information

NPI: 1245120849
Provider Name (Legal Business Name): BRADLEY STOKES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 LEIGH DR
COLUMBUS MS
39705-3036
US

IV. Provider business mailing address

260 BELLE ROSE CIR
MADISON MS
39110-9431
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1825
  • Fax:
Mailing address:
  • Phone: 601-813-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111196
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: