Provider Demographics
NPI:1588851612
Name:ROWE, BRADFORD SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:SCOTT
Last Name:ROWE
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 1:10277 N STRAITS HWY
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-8839
Mailing Address - Country:US
Mailing Address - Phone:231-627-7131
Mailing Address - Fax:231-627-8972
Practice Address - Street 1:10277 N STRAITS HWY
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-8839
Practice Address - Country:US
Practice Address - Phone:231-627-7131
Practice Address - Fax:231-627-8972
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010138121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice