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General NPI Number Information
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NPI Number | 1962510610
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Entity Type | Individual
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Provider Name | BRADLEY RAYMOND BENDUSH DDS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 115 N SHORTRIDGE RD SUITE #200
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4908
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Country | US
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Telephone | 317-353-1062
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Fax | 317-357-5999
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Provider Business Mailing Address
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Address Line | 115 N SHORTRIDGE RD SUITE #200
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4908
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Country | US
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Telephone | 317-353-1062
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Fax | 317-357-5999
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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 | 12008546
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License Number State | IN
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