Provider Demographics
NPI:1508427030
Name:SITTASON, BRADEE AIYER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADEE
Middle Name:AIYER
Last Name:SITTASON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-4802
Mailing Address - Country:US
Mailing Address - Phone:256-262-0200
Mailing Address - Fax:256-741-7340
Practice Address - Street 1:310 W ELM ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4802
Practice Address - Country:US
Practice Address - Phone:256-262-0200
Practice Address - Fax:256-741-7340
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006651-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice