Individual
BRADLEY GEORGE PATCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
167 E 200 N, # 4, LOGAN, UT 84321-4049
(435) 512-6566
Mailing address
167 E 200 N, # 4, LOGAN, UT 84321-4049
(435) 512-6566
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1441559922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0405787210
—
UT
Enumeration date
12/22/2011
Last updated
12/22/2011
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