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General NPI Number Information
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NPI Number | 1467677344
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Entity Type | Organization
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Legal Business Name | CHARLES W BRADLEY DDS PA
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8315 WALNUT HILL LN 200
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City | DALLAS
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State | TX
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Zip | 75231-4218
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Country | US
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Telephone | 214-378-7930
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Fax |
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Provider Business Mailing Address
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Address Line | 8315 WALNUT HILL LN 200
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City | DALLAS
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State | TX
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Zip | 75231-4218
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Country | US
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Telephone | 214-378-7930
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES WESLEY BRADLEY
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Credential | DDS
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Telephone | 214-378-7930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13064
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License Number State | TX
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