Provider Demographics
NPI:1104985191
Name:BRADLEY, PAUL FRANK I (BDS,MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANK
Last Name:BRADLEY
Suffix:I
Gender:M
Credentials:BDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CARROTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-8240
Mailing Address - Country:US
Mailing Address - Phone:954-472-6446
Mailing Address - Fax:954-262-1782
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1744
Practice Address - Fax:954-262-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPNU#79122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist