Provider Demographics
NPI:1760590129
Name:ENGLE, BRADLEY J (DMD MHS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:ENGLE
Suffix:
Gender:M
Credentials:DMD MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 NAPLES BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-593-2178
Mailing Address - Fax:239-593-2179
Practice Address - Street 1:1390 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5203
Practice Address - Country:US
Practice Address - Phone:239-593-2178
Practice Address - Fax:239-593-2179
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15286122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist