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General NPI Number Information
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NPI Number | 1033309489
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Entity Type | Organization
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Legal Business Name | BRADLEY R. HARMON, DDS, PLC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 2501 BUSH RIDGE DRIVE
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City | LOUISVILLE
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State | KY
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Zip | 40245
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Country | US
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Telephone | 614-352-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 BUSH RIDGE DRIVE
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City | LOUISVILLE
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State | KY
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Zip | 40245
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Country | US
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Telephone | 614-352-3050
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRADLEY R. HARMON
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Credential | D.D.S.
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Telephone | 614-352-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8305
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License Number State | KY
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