Provider Demographics
NPI:1447516794
Name:CARN, BRADLEY ROSS (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROSS
Last Name:CARN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:222 S WOODS MILL RD STE 720N
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3650
Mailing Address - Country:US
Mailing Address - Phone:314-434-0493
Mailing Address - Fax:
Practice Address - Street 1:222 S WOODS MILL RD STE 720N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-434-0493
Practice Address - Fax:314-434-7883
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180088641223S0112X
ALD59981223S0112X
390200000X
MO2018228864204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program