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General NPI Number Information
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NPI Number | 1295577799
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Entity Type | Individual
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Provider Name | BRADLEY JOSEPH BROW DMD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 9115 TELEGRAPH ROAD
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City | TAYLOR
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State | MI
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Zip | 48180-2365
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Country | US
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Telephone | 313-908-1788
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Fax |
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Provider Business Mailing Address
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Address Line | 1448 WOODWARD AVE APT 202
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City | DETROIT
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State | MI
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Zip | 48226-2020
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Country | US
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Telephone | 906-235-3814
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901602263
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License Number State | MI
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