Healthcare Provider Details

I. General information

NPI: 1760578819
Provider Name (Legal Business Name): SEAN E BRADLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 WHITEHORSE MERCERVILLE ROAD
MERCERVILLE NJ
08619-1994
US

IV. Provider business mailing address

2303 WHITEHORSE MERCERVILLE ROAD
MERCERVILLE NJ
08619-1994
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-2900
  • Fax: 605-587-1749
Mailing address:
  • Phone: 609-587-2900
  • Fax: 605-587-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01606500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: