Individual
BRADLEY JOHN BURKET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.,M.D.
Contact information
Practice address
2195 NE PROFESSIONAL CT, STE 1, BEND, OR 97701-6028
(541) 322-9396
(541) 322-9398
Mailing address
2195 NE PROFESSIONAL CT, STE 1, BEND, OR 97701-6028
(541) 322-9396
(541) 322-9398
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D6600
OR
207Q00000X
Family Medicine Physician
Primary
MD19055
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002955000
BCBS
OR
05
—
080507
—
OR
01
—
100117
COIHS
OR
01
—
1156820001
CIGNA
OR
01
—
7608077
AETNA
OR
Enumeration date
06/23/2006
Last updated
01/17/2012
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