Provider Demographics
NPI:1578646758
Name:SMITH, BRADLEY D (DMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 FREEPORT RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3110
Mailing Address - Country:US
Mailing Address - Phone:412-963-7760
Mailing Address - Fax:412-967-1030
Practice Address - Street 1:1376 FREEPORT RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3110
Practice Address - Country:US
Practice Address - Phone:412-963-7760
Practice Address - Fax:412-967-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029629L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics