Organization
BRADLEY J. BROWN D.D.S.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY JESSE BROWN D.D.S. (PRES OF CORP/OWNER DENTIST)
(724) 752-1506
Entity
Organization
Contact information
Practice address
101 5TH ST, ELLWOOD CITY, PA 16117-2303
(724) 752-1506
(724) 752-2018
Mailing address
101 5TH ST, ELLWOOD CITY, PA 16117-2303
(724) 752-1506
(724) 752-2018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS025807L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BR509853
UNITED CONCORDIA PROVIDER
PA
Enumeration date
02/13/2006
Last updated
06/16/2008
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