Provider Demographics
NPI:1437529641
Name:DAVIS, BRADLEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEE
Middle Name:
Last Name:DAVIS
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 1:9680 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9205
Mailing Address - Country:US
Mailing Address - Phone:775-323-4054
Mailing Address - Fax:775-323-4167
Practice Address - Street 1:9680 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9205
Practice Address - Country:US
Practice Address - Phone:775-323-4054
Practice Address - Fax:775-323-4167
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV67141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice