Provider Demographics
NPI:1760619118
Name:SZUTZ, BRADLEY JOHN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOHN
Last Name:SZUTZ
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR. SUITE #265
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-278-5678
Mailing Address - Fax:907-258-4170
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR. SUITE #265
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-278-5678
Practice Address - Fax:907-258-4170
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537341223S0112X
AZ65681223S0112X
HI22161223S0112X
AK14091223S0112X
OH30-0236181223S0112X
OH0990211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery