Provider Demographics
NPI:1831127935
Name:BRADLEY, STEVEN P (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:P
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:714 1ST AVE E
Mailing Address - Street 2:P.O. BOX 327
Mailing Address - City:CASCADE
Mailing Address - State:IA
Mailing Address - Zip Code:52033-9799
Mailing Address - Country:US
Mailing Address - Phone:563-852-7390
Mailing Address - Fax:563-852-7534
Practice Address - Street 1:714 1ST AVE E
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:IA
Practice Address - Zip Code:52033-9799
Practice Address - Country:US
Practice Address - Phone:563-852-7390
Practice Address - Fax:563-852-7534
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice