Provider Demographics
NPI:1992259998
Name:OLIVER, BRADLEY RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RICHARD
Last Name:OLIVER
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 1:4572 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5144
Mailing Address - Country:US
Mailing Address - Phone:540-769-5020
Mailing Address - Fax:540-769-5021
Practice Address - Street 1:4572 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5144
Practice Address - Country:US
Practice Address - Phone:540-769-5020
Practice Address - Fax:540-769-5021
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415365122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice