Individual
DR. BRADLEY DALE HARRELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4400 E HIGHWAY 20 STE 111, NICEVILLE, FL 32578-9735
(850) 897-4171
(850) 897-4622
Mailing address
4400 E HIGHWAY 20 STE 111, NICEVILLE, FL 32578-9735
(850) 897-4171
(850) 897-4622
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3428-07
MS
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN24799
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
OS-519-16
MS
Other
Enumeration date
08/13/2007
Last updated
04/22/2024
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