Provider Demographics
NPI:1235895772
Name:BRADLE PLASTER LEMONE PLLC
Entity Type:Organization
Organization Name:BRADLE PLASTER LEMONE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-610-5708
Mailing Address - Street 1:507 S WASHINGTON ST STE 40
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2614
Mailing Address - Country:US
Mailing Address - Phone:702-610-5708
Mailing Address - Fax:
Practice Address - Street 1:3606 S REGAL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4648
Practice Address - Country:US
Practice Address - Phone:509-534-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental