Provider Demographics
NPI:1386748887
Name:DICKEY, BRADFORD HUGH (DDS)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:HUGH
Last Name:DICKEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SOUTH HAM LANE
Mailing Address - Street 2:SUITE L
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7502
Mailing Address - Country:US
Mailing Address - Phone:209-334-0630
Mailing Address - Fax:209-334-0541
Practice Address - Street 1:801 SOUTH HAM LANE
Practice Address - Street 2:SUITE L
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7502
Practice Address - Country:US
Practice Address - Phone:209-334-0630
Practice Address - Fax:209-334-0541
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice