=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740403138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRADLEY T. PIOTROWSKI, DDS, MSD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1044 CASTELLO DR SUITE 202
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-8901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-6003
-----------------------------------------------------
Fax | 239-263-2579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1044 CASTELLO DR SUITE 202
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-8901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-6003
-----------------------------------------------------
Fax | 239-263-2579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. BRADLEY THOMAS PIOTROWSKI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 239-263-6003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DN15584
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------