Provider Demographics
NPI:1225560519
Name:BRADLEY P DILLING DMD PA
Entity Type:Organization
Organization Name:BRADLEY P DILLING DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-454-1150
Mailing Address - Street 1:13981 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6130
Mailing Address - Country:US
Mailing Address - Phone:239-454-1150
Mailing Address - Fax:239-454-6399
Practice Address - Street 1:13981 MCGREGOR BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6130
Practice Address - Country:US
Practice Address - Phone:239-454-1150
Practice Address - Fax:239-454-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL182671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty