Provider Demographics
NPI:1033371653
Name:DILLING, BRADLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:DILLING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15751 SAN CARLOS BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3314
Mailing Address - Country:US
Mailing Address - Phone:239-454-1150
Mailing Address - Fax:239-454-6399
Practice Address - Street 1:15751 SAN CARLOS BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3314
Practice Address - Country:US
Practice Address - Phone:239-454-1150
Practice Address - Fax:239-454-6399
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice