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NPI Code Detail

MEDICARE: DR. DAVID CHRISTOPHER BRADLEY D.M.D.

MEDICARE: DR. DAVID CHRISTOPHER BRADLEY D.M.D.
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
11223G0001XGeneral Practice Dentistry11650GA

General Provider Information

NPI Number : 1730182411
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID CHRISTOPHER BRADLEY D.M.D.
Provider Business Mailing Address
First Line : 1011 PARKSIDE MAIN
Second Line :
City : GREENSBORO
State : GA
Zip : 30642-4543
Country : US
Telephone Number : 706-453-1333
Fax Number : 706-453-7001
Provider Business Practice Location Address
First Line : 1011 PARKSIDE MAIN
Second Line :
City : GREENSBORO
State : GA
Zip : 30642-4543
Country : US
Telephone Number : 706-453-1333
Fax Number : 706-453-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 12/26/2013

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