Provider Demographics
NPI:1114309291
Name:HOBSON, BRADLEY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:HOBSON
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 1:2515 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3013
Mailing Address - Country:US
Mailing Address - Phone:406-761-1945
Mailing Address - Fax:406-761-2688
Practice Address - Street 1:2515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3013
Practice Address - Country:US
Practice Address - Phone:406-761-1945
Practice Address - Fax:406-761-2688
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4668122300000X
MT13360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist