Provider Demographics
NPI:1558575985
Name:HARMON, BRADLEY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RAY
Last Name:HARMON
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 1:2501 BUSH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5885
Mailing Address - Country:US
Mailing Address - Phone:502-245-3602
Mailing Address - Fax:502-245-3603
Practice Address - Street 1:2501 BUSH RIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5885
Practice Address - Country:US
Practice Address - Phone:502-245-3602
Practice Address - Fax:502-245-3603
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013294A122300000X
OH30-0221851223G0001X
KY83051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist