Individual
DR. BRADLEY K JEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
17991 MAHONING AVE, LAKE MILTON, OH 44429
(330) 654-3253
(330) 654-3252
Mailing address
17991 MAHONING AVE, LAKE MILTON, OH 44429
(330) 654-3253
(330) 654-3252
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
OH17658
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0591622
—
OH
Enumeration date
08/04/2006
Last updated
07/08/2007
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