Organization
JERRY BRADLEY DDS AND ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY LEWIS BRADLEY DDS (OWNER/DENTIST)
(252) 482-1080
Entity
Organization
Contact information
Practice address
512 COKE AVE, EDENTON, NC 27932-1539
(252) 482-1080
(252) 482-1082
Mailing address
PO BOX 552, 512 COKE AVENUE, EDENTON, NC 27932-0552
(252) 482-1080
(252) 482-1082
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5267
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7990844
—
NC
Enumeration date
09/11/2006
Last updated
08/22/2020
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