Provider Demographics
NPI:1093758476
Name:BRADLEY A. SAMUEL DDS., P.A.
Entity type:Organization
Organization Name:BRADLEY A. SAMUEL DDS., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-883-2316
Mailing Address - Street 1:1001 N. LINDSAY STREET
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3905
Mailing Address - Country:US
Mailing Address - Phone:336-883-2316
Mailing Address - Fax:336-883-7686
Practice Address - Street 1:1001 N. LINDSAY STREET
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3905
Practice Address - Country:US
Practice Address - Phone:336-883-2316
Practice Address - Fax:336-883-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty