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General NPI Number Information
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NPI Number | 1710573548
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Entity Type | Organization
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Legal Business Name | BRADLEY JOHNSON D.M.D., M.S.D., LLC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 7288 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-7578
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Country | US
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Telephone | 440-946-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 LANDER RD
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-1434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | BRADLEY R JOHNSON
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Credential | D.M.D, M.S.D.
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Telephone | 440-946-0088
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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 |
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License Number State |
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