Provider Demographics
NPI:1447601174
Name:PLASHA, BRADFORD (DMD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:PLASHA
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 1:222 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2650
Mailing Address - Country:US
Mailing Address - Phone:484-854-6900
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2650
Practice Address - Country:US
Practice Address - Phone:484-854-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02642900122300000X
PADS0421221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist