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General NPI Number Information
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NPI Number | 1003048752
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Entity Type | Organization
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Legal Business Name | BRADFORD L PICOT, DDS, P.A.
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1520 SOUTH BLVD SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28203-4786
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Country | US
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Telephone | 704-335-8266
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Fax | 704-335-8267
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Provider Business Mailing Address
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Address Line | 1520 SOUTH BLVD SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28203-4786
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Country | US
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Telephone | 704-335-8266
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Fax | 704-335-8267
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRADFORD LEE PICOT
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Credential | DDS
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Telephone | 704-335-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 8158
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8158
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License Number State | NC
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