Individual
DR. BRADLEY R JURGENSMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4902 MAIN ST STE A, SHALLOTTE, NC 28470-4749
(910) 754-8289
Mailing address
4902 MAIN ST STE A, SHALLOTTE, NC 28470-4749
(910) 754-8289
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12154
NC
122300000X
Dentist
D009785
AZ
Other
Enumeration date
06/22/2017
Last updated
05/16/2023
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