Provider Demographics
NPI:1437397981
Name:BRADBURY, G. MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:MICHAEL
Last Name:BRADBURY
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 1:31525 LARGA VIS
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-5037
Mailing Address - Country:US
Mailing Address - Phone:760-751-1155
Mailing Address - Fax:
Practice Address - Street 1:31525 LARGA VIS
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5037
Practice Address - Country:US
Practice Address - Phone:760-751-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice