MEDICARE: DR. BRADLEY G. ACKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.027076	OH
2	1223G0001X	General Practice Dentistry	5831	OK

General Provider Information

NPI Number	:	1356304182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY G. ACKER DDS

Provider Business Mailing Address
First Line	:	6826 US HIGHWAY 59
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-4486
Country	:	US
Telephone Number	:	918-787-9711
Fax Number	:	918-787-9711

Provider Business Practice Location Address
First Line	:	1922 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1017
Country	:	US
Telephone Number	:	918-314-6467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	03/13/2023

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