Provider Demographics
NPI:1841213253
Name:BOURCY, BRADLEY DUANE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DUANE
Last Name:BOURCY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E GRAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3435
Mailing Address - Country:US
Mailing Address - Phone:760-741-4061
Mailing Address - Fax:
Practice Address - Street 1:850 E GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3435
Practice Address - Country:US
Practice Address - Phone:760-741-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0426371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics