MEDICARE: DR. BRADLEY RAY HARMON D.D.S.

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	12013294A	IN
2	1223G0001X	General Practice Dentistry	30-022185	OH
3	1223G0001X	General Practice Dentistry	8305	KY

General Provider Information

NPI Number	:	1558575985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY RAY HARMON D.D.S.

Provider Business Mailing Address
First Line	:	2501 BUSH RIDGE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-245-3602
Fax Number	:	502-245-3603

Provider Business Practice Location Address
First Line	:	2501 BUSH RIDGE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-245-3602
Fax Number	:	502-245-3603

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	02/12/2021

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