Provider Demographics
NPI:1851301733
Name:VICKERS, BRADLEY PERRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:PERRY
Last Name:VICKERS
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 1:700 SOUTH 19TH STREET
Mailing Address - Street 2:VA MEDICAL CENTER, DENTAL SERVICE 160
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233
Mailing Address - Country:US
Mailing Address - Phone:205-933-8101
Mailing Address - Fax:205-558-4779
Practice Address - Street 1:700 SOUTH 19TH ST
Practice Address - Street 2:VA MEDICAL CENTER, DENTAL SERVICE 160
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:205-558-4779
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL52661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics