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General NPI Number Information
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NPI Number | 1205960796
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Entity Type | Organization
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Legal Business Name | BRADLEY J. SMITH D.D.S. PC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 238 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5696
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Country | US
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Telephone | 816-524-4880
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Fax | 816-524-2868
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Provider Business Mailing Address
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Address Line | 238 NE TUDOR RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5696
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Country | US
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Telephone | 816-524-4880
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Fax | 816-524-2868
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY JOSEPH SMITH
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Credential | D.D.S
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Telephone | 816-524-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15223
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License Number State | MO
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