Provider Demographics
NPI:1285858050
Name:DANA, BRADLY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:RAY
Last Name:DANA
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 1:1306 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1503
Mailing Address - Country:US
Mailing Address - Phone:605-642-7727
Mailing Address - Fax:605-642-4344
Practice Address - Street 1:1306 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1503
Practice Address - Country:US
Practice Address - Phone:605-642-7727
Practice Address - Fax:605-642-4344
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice