MEDICARE: BRADLEY R HEPLER DDS PC

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	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry	12465	GA

General Provider Information

NPI Number	:	1992899959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY R HEPLER DDS PC

Provider Business Mailing Address
First Line	:	11190 HAYNES BRIDGE RD
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4810
Country	:	US
Telephone Number	:	866-687-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	11190 HAYNES BRIDGE RD
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4810
Country	:	US
Telephone Number	:	866-687-1992
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRADLEY HEPLER
Credential	:	DDS
Telephone Number	:	866-687-1992

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/21/2022

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