Individual
BRENT J. BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
700 SHERIDAN LAKE RD, RAPID CITY, SD 57702-2407
(605) 341-3068
Mailing address
700 SHERIDAN LAKE RD, RAPID CITY, SD 57702-2407
(605) 341-3068
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
M864
SD
Other
Enumeration date
03/24/2006
Last updated
08/28/2007
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