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Organization
BRADFORD L PICOT, DDS, P.A.
Active
Organization
BRADFORD L PICOT, DDS, P.A.
Active
Other names
Southend Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD LEE PICOT DDS (OWNER/DENTIST)
(704) 335-8266
Entity
Organization
Contact information
Practice address
1520 SOUTH BLVD, SUITE 110, CHARLOTTE, NC 28203-4786
(704) 335-8266
(704) 335-8267
Mailing address
1520 SOUTH BLVD, SUITE 110, CHARLOTTE, NC 28203-4786
(704) 335-8266
(704) 335-8267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8158
NC
302R00000X
Health Maintenance Organization
8158
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5908420
—
NC
Enumeration date
08/13/2009
Last updated
08/13/2009
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