Provider Demographics
NPI:1821012485
Name:GERDES, BRAD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JOSEPH
Last Name:GERDES
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 1:6932 N SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3942
Mailing Address - Country:US
Mailing Address - Phone:414-332-6212
Mailing Address - Fax:414-332-4710
Practice Address - Street 1:6932 N SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3942
Practice Address - Country:US
Practice Address - Phone:414-332-6212
Practice Address - Fax:414-332-4710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist