Provider Demographics
NPI:1306035654
Name:BRADLEY J. LAGERS DMD, PC
Entity Type:Organization
Organization Name:BRADLEY J. LAGERS DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-996-1660
Mailing Address - Street 1:4845 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3556
Mailing Address - Country:US
Mailing Address - Phone:602-996-1660
Mailing Address - Fax:
Practice Address - Street 1:4845 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3556
Practice Address - Country:US
Practice Address - Phone:602-996-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2390261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental