Individual
DR. BRADLEY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2458 SE BURNSIDE RD, GRESHAM, OR 97080-1247
(503) 666-8045
Mailing address
2458 SE BURNSIDE RD, GRESHAM, OR 97080-1247
(503) 666-8045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7229
OR
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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