Provider Demographics
NPI:1457455024
Name:BRADLEY, STEPHEN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:BRADLEY
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 1:821 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6313
Mailing Address - Country:US
Mailing Address - Phone:405-321-5823
Mailing Address - Fax:405-321-6466
Practice Address - Street 1:821 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6313
Practice Address - Country:US
Practice Address - Phone:405-321-5823
Practice Address - Fax:405-321-6466
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist