Provider Demographics
NPI:1386752392
Name:BRADLEY, DARCIE (DMD)
Entity type:Individual
Prefix:DR
First Name:DARCIE
Middle Name:
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 1:5947 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-6244
Mailing Address - Country:US
Mailing Address - Phone:513-385-2161
Mailing Address - Fax:
Practice Address - Street 1:5947 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-6244
Practice Address - Country:US
Practice Address - Phone:513-385-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-11751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics