Individual
AMANDA PAIGE BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4641 E FRONTIER PLAZA DR, WASILLA, AK 99654
(907) 373-2227
Mailing address
192 W CELTIC CIR # 1, WASILLA, AK 99654-6431
(702) 510-6683
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
196841
AK
1223G0001X
General Practice Dentistry
Primary
196841
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1733188
—
AK
Enumeration date
10/05/2022
Last updated
10/27/2022
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