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General NPI Number Information
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NPI Number | 1861592230
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Entity Type | Individual
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Provider Name | SUSAN M BRADLEY-BOEHME DMD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 312 2ND AVE
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City | CARNEGIE
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State | PA
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Zip | 15106-2509
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Country | US
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Telephone | 412-279-7366
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Fax | 412-279-7366
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Provider Business Mailing Address
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Address Line | 103 CEDARBROOK CT
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City | MCMURRAY
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State | PA
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Zip | 15317
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Country | US
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Telephone | 724-942-4551
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS024633L
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License Number State | PA
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