Individual
BRADLEY M. HENGEHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2300 W BROAD ST, COLUMBUS, OH 43204-3783
(614) 859-1830
(614) 458-1192
Mailing address
PO BOX 16370, COLUMBUS, OH 43216-6370
(614) 645-5500
(614) 645-5517
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30023237
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3060637
—
OH
Enumeration date
08/09/2010
Last updated
10/30/2013
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