# JERRY BRADLEY DDS AND ASSOCIATES PLLC

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

## Provider details

- **NPI number:** 1629172812
- **Authorized official:** DR. JERRY LEWIS BRADLEY DDS (OWNER/DENTIST)
- **Authorized official phone:** (252) 482-1080

## Contact information

- **Practice address:** 512 COKE AVE, EDENTON, NC 27932-1539
- **Practice address phone:** (252) 482-1080
- **Practice address fax:** (252) 482-1082
- **Mailing address:** PO BOX 552, 512 COKE AVENUE, EDENTON, NC 27932-0552
- **Mailing address phone:** (252) 482-1080
- **Mailing address fax:** (252) 482-1082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5267 | NC | Yes |

## Other

- **Enumeration date:** 09/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7990844 | — | NC |