Healthcare Provider Details

I. General information

NPI: 1306946223
Provider Name (Legal Business Name): BRADLEY SCOTT HARLANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S WISCONSIN AVE
FREDERIC WI
54837-0250
US

IV. Provider business mailing address

PO BOX 250
FREDERIC WI
54837-0250
US

V. Phone/Fax

Practice location:
  • Phone: 715-327-8607
  • Fax: 715-327-4376
Mailing address:
  • Phone: 715-327-8607
  • Fax: 715-327-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2349015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: