Provider Demographics
NPI:1639275175
Name:SAMMONS, BRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:SAMMONS
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 1:8325 S EMERSON AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8558
Mailing Address - Country:US
Mailing Address - Phone:317-859-6768
Mailing Address - Fax:317-859-0144
Practice Address - Street 1:8325 S EMERSON AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8558
Practice Address - Country:US
Practice Address - Phone:317-859-6768
Practice Address - Fax:317-859-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist