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Individual
BRADLEY RANDALL CONGLETON
Active
Individual
BRADLEY RANDALL CONGLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12014346A
IN
1223D0001X
Public Health Dentistry
Primary
9824
KY
1223G0001X
General Practice Dentistry
9824
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100435410
—
KY
Enumeration date
07/18/2016
Last updated
11/18/2024
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