Provider Demographics
NPI:1346251378
Name:BRAGDON, RANDON E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDON
Middle Name:E
Last Name:BRAGDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2518
Mailing Address - Country:US
Mailing Address - Phone:207-947-0284
Mailing Address - Fax:
Practice Address - Street 1:30 JUDSON BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2518
Practice Address - Country:US
Practice Address - Phone:207-947-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice