Provider Demographics
NPI:1861592230
Name:BRADLEY-BOEHME, SUSAN M (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:BRADLEY-BOEHME
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 1:103 CEDARBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-942-4551
Mailing Address - Fax:
Practice Address - Street 1:312 2ND AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-2509
Practice Address - Country:US
Practice Address - Phone:412-279-7366
Practice Address - Fax:412-279-7366
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024633L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist