Individual
BRADLEY MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8700 MARBACH RD, SAN ANTONIO, TX 78245
(970) 214-8735
(210) 568-4774
Mailing address
8700 MARBACH RD, SAN ANTONIO, TX 78227-2345
(210) 675-7000
(210) 568-4774
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25764
TX
122300000X
Dentist
9088
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25764
TEXAS LICENSE
TX
01
—
9088
STATE LICENSE
CO
Enumeration date
07/12/2007
Last updated
07/18/2011
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