Provider Demographics
NPI:1205847928
Name:ELLER, BRAD S (DDS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:S
Last Name:ELLER
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 1:13455 CUTTEN RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069
Mailing Address - Country:US
Mailing Address - Phone:281-866-0442
Mailing Address - Fax:281-866-8076
Practice Address - Street 1:13455 CUTTEN RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069
Practice Address - Country:US
Practice Address - Phone:281-866-0442
Practice Address - Fax:281-866-8076
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist