Provider Demographics
NPI:1033243803
Name:PICOT, BRADFORD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:LEE
Last Name:PICOT
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 1:545 NEW BERN STATION CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1154
Mailing Address - Country:US
Mailing Address - Phone:704-521-2517
Mailing Address - Fax:
Practice Address - Street 1:518 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5110
Practice Address - Country:US
Practice Address - Phone:704-332-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice