Provider Demographics
NPI:1659403095
Name:DICKENS, BRADLEY LAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LAMAR
Last Name:DICKENS
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 1:10607 FINCHLEY DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3502
Mailing Address - Country:US
Mailing Address - Phone:661-665-2603
Mailing Address - Fax:661-665-2403
Practice Address - Street 1:210 S MONTCLAIR ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3164
Practice Address - Country:US
Practice Address - Phone:661-397-0665
Practice Address - Fax:661-397-0370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0357101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice