# BRADLEY DENTAL

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

## Provider details

- **NPI number:** 1770848129
- **Authorized official:** DANA HORSCH (MANAGER)
- **Authorized official phone:** (586) 757-7540

## Contact information

- **Practice address:** 21635 RYAN RD, WARREN, MI 48091-2788
- **Practice address phone:** (586) 757-7540
- **Mailing address:** 21635 RYAN RD, WARREN, MI 48091-2788
- **Mailing address phone:** (586) 757-7540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 15917 | MI | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2451596 | MI | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | MI | — |
| 332BC3200X | Customized Equipment (DME) | 15917 | MI | — |

## Other

- **Enumeration date:** 07/11/2012
- **Last updated:** 09/09/2014