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NPI Code Detail

MEDICARE: DR. GEORGE BRADLEY GOTTSEGEN DDS

MEDICARE:  DR. GEORGE BRADLEY GOTTSEGEN  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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry4879LA

General Provider Information

NPI Number : 1467589150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE BRADLEY GOTTSEGEN DDS
Provider Business Mailing Address
First Line : 399 BROADWAY ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70118-3559
Country : US
Telephone Number : 504-232-6964
Fax Number : 504-899-4872
Provider Business Practice Location Address
First Line : 3424 COLISEUM ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70115-2427
Country : US
Telephone Number : 504-895-4841
Fax Number : 504-899-4872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/08/2007

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Directions to “ DR. GEORGE BRADLEY GOTTSEGEN DDS” Practice Location

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