Provider Demographics
NPI:1487866836
Name:ROWE, BRADLEY E (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
Last Name:ROWE
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 1:4512 VALDEZ CT
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-5000
Mailing Address - Country:US
Mailing Address - Phone:509-392-9556
Mailing Address - Fax:
Practice Address - Street 1:1408 N LOUISIANA ST STE 101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7167
Practice Address - Country:US
Practice Address - Phone:509-737-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34701223G0001X
WADE000108871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice