# BRADLEY T FREDERICK DMD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487475737
- **Authorized official:** BRADLEY FREDERICK DMD (MANAGER)
- **Authorized official phone:** (502) 552-4559

## Contact information

- **Practice address:** 1935 APPLE BLOSSOM DR, FLOYDS KNOBS, IN 47119-9025
- **Practice address phone:** (502) 552-4559
- **Mailing address:** 1935 APPLE BLOSSOM DR, FLOYDS KNOBS, IN 47119-9025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 10/21/2024
- **Last updated:** 10/21/2024