Individual
DR. BRADLEY DAVID WILTBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401414248
VA
1223G0001X
General Practice Dentistry
D8944
OR
1223G0001X
General Practice Dentistry
DE00011246
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401414248
VA
Other
Enumeration date
07/10/2007
Last updated
12/30/2021
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