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General NPI Number Information
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NPI Number | 1093237729
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Entity Type | Individual
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Provider Name | BRADLEY MICHEL HERMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 11/18/2023
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Provider Practice Location Address
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Address Line | 3700 W 83RD ST STE 215
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5120
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Country | US
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Telephone | 913-381-5292
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Fax |
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Provider Business Mailing Address
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Address Line | 17297 W 93RD PL
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City | LENEXA
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State | KS
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Zip | 66219-2597
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Country | US
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Telephone | 913-485-5320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2020007084
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61569
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License Number State | KS
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