Individual
BRADLEY RANDALL CONGLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
(502) 996-8309
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 772-8160
(502) 772-8108
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12014346A
IN
1223D0001X
Public Health Dentistry
Primary
9824
KY
1223G0001X
General Practice Dentistry
9824
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100435410
—
KY
Enumeration date
07/18/2016
Last updated
11/18/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us