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Organization

BRADLEY DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANA HORSCH (MANAGER)
(586) 757-7540
Entity
Organization

Contact information

Practice address
21635 RYAN RD, WARREN, MI 48091-2788
(586) 757-7540
Mailing address
21635 RYAN RD, WARREN, MI 48091-2788
(586) 757-7540

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15917
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2451596
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
MI
332BC3200X
Customized Equipment (DME)
15917
MI

Other

Enumeration date
07/11/2012
Last updated
09/09/2014
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