Provider Demographics
NPI:1356304182
Name:ACKER, BRADLEY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:G
Last Name:ACKER
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 1:6826 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-4486
Mailing Address - Country:US
Mailing Address - Phone:918-787-9711
Mailing Address - Fax:918-787-9711
Practice Address - Street 1:1922 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1017
Practice Address - Country:US
Practice Address - Phone:918-314-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027076122300000X
OK58311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice