Healthcare Provider Details

I. General information

NPI: 1114309291
Provider Name (Legal Business Name): BRADLEY R. HOBSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 6TH AVE S
GREAT FALLS MT
59405-3013
US

IV. Provider business mailing address

2515 6TH AVE S
GREAT FALLS MT
59405-3013
US

V. Phone/Fax

Practice location:
  • Phone: 406-761-1945
  • Fax: 406-761-2688
Mailing address:
  • Phone: 406-761-1945
  • Fax: 406-761-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4668
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13360
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: