Provider Demographics
NPI:1588828784
Name:WURTH, BRADLEY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALAN
Last Name:WURTH
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 1:39 BOGLE OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2810
Mailing Address - Country:US
Mailing Address - Phone:606-451-0888
Mailing Address - Fax:
Practice Address - Street 1:127 WELL PARK LN
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4999
Practice Address - Country:US
Practice Address - Phone:270-469-1156
Practice Address - Fax:270-469-1158
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8507 9191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery