Provider Demographics
NPI:1235132911
Name:BRADLEY, PATTI JUNE (DMD)
Entity type:Individual
Prefix:DR
First Name:PATTI
Middle Name:JUNE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PARKSIDE MAIN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4543
Mailing Address - Country:US
Mailing Address - Phone:706-453-1333
Mailing Address - Fax:706-453-7001
Practice Address - Street 1:1011 PARKSIDE MAIN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4543
Practice Address - Country:US
Practice Address - Phone:706-453-1333
Practice Address - Fax:706-453-7001
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA116561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice