Provider Demographics
NPI:1497307987
Name:SLEETH, BRADLEY (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:SLEETH
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 ORTEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8417
Mailing Address - Country:US
Mailing Address - Phone:904-503-0049
Mailing Address - Fax:
Practice Address - Street 1:5405 ORTEGA BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8417
Practice Address - Country:US
Practice Address - Phone:904-503-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN237311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics