Thomas Gerard Bradley Valid NPI

Individual provider · Orthodontics and Dentofacial Orthopedics Dentistry · Watertown, WI

NPI

1346461696

Type

Individual (Type 1)

Primary specialty

Orthodontics and Dentofacial Orthopedics Dentistry (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223X0400X

License number

5275-015 (WI)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-05-02

Last updated

2007-07-08