Individual
BRADLEY WISOWATY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
809 WALL ST STE A, VALPARAISO, IN 46383-2571
(219) 464-9681
Mailing address
809 WALL ST STE A, VALPARAISO, IN 46383-2571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012301A
IN
1223G0001X
General Practice Dentistry
12012301A
IN
Other
Enumeration date
07/07/2015
Last updated
11/27/2018
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