Provider Demographics
NPI:1700395308
Name:ZEMKE, BRADLEY THOMAS (DMD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:THOMAS
Last Name:ZEMKE
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 1:876 STEWART RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-241-6550
Mailing Address - Fax:734-241-0824
Practice Address - Street 1:876 STEWART RD.
Practice Address - Street 2:SUITE D
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-241-6550
Practice Address - Fax:734-241-0824
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223841223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice