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Individual

DR. BRAD A TWADDLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1906 CORONA RD, STE 200, COLUMBIA, MO 65203
(573) 234-2774
Mailing address
3705 HUNTER VALLEY DR, COLUMBIA, MO 65203
(573) 445-7482

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
015724
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
015724
LICENSE #
MO
01
1795492-7
TAX ID #
MO
Enumeration date
09/05/2006
Last updated
07/08/2007
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