Provider Demographics
NPI:1790840825
Name:KRAMER, BRADLEY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:KRAMER
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:ROUTE 2 BOX 665
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837
Mailing Address - Country:US
Mailing Address - Phone:618-599-9433
Mailing Address - Fax:
Practice Address - Street 1:301 NW 11TH STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837
Practice Address - Country:US
Practice Address - Phone:618-842-2801
Practice Address - Fax:618-847-7911
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19024807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist