Individual
BRADLEY R DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
315 W MULBERRY, PILOT KNOB, MO 63663
(573) 546-1001
(573) 546-1002
Mailing address
110 S 2ND ST, ELLINGTON, MO 63638-9400
(573) 663-2313
(573) 663-2441
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2012024991
MO
Other
Enumeration date
07/30/2012
Last updated
07/21/2022
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