Provider Demographics
NPI:1760573273
Name:MCGOWAN, BRADFORD KIRBY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:KIRBY
Last Name:MCGOWAN
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 1:50 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-3401
Mailing Address - Country:US
Mailing Address - Phone:603-465-8030
Mailing Address - Fax:603-435-8107
Practice Address - Street 1:50 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-3401
Practice Address - Country:US
Practice Address - Phone:603-465-8030
Practice Address - Fax:603-435-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice