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Organization
JERRY BRADLEY DDS AND ASSOCIATES PLLC
Active
Organization
JERRY BRADLEY DDS AND ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY LEWIS BRADLEY DDS (OWNER/DENTIST)
(252) 482-1080
Entity
Organization
Contact information
Practice address
512 COKE AVE, EDENTON, NC 27932-1539
(252) 482-1080
(252) 482-1082
Mailing address
PO BOX 552, 512 COKE AVENUE, EDENTON, NC 27932-0552
(252) 482-1080
(252) 482-1082
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5267
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7990844
—
NC
Enumeration date
09/11/2006
Last updated
08/22/2020
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