Provider Demographics
NPI:1437163078
Name:RICHENS, BRADLEY M
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:M
Last Name:RICHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8954 SPANISH RIDGE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1353
Mailing Address - Country:US
Mailing Address - Phone:702-433-1889
Mailing Address - Fax:702-364-0022
Practice Address - Street 1:8954 SPANISH RIDGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1353
Practice Address - Country:US
Practice Address - Phone:702-433-1889
Practice Address - Fax:702-364-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVQ07-01160-4-095331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist