Provider Demographics
NPI:1851571301
Name:PULFER, BRADLEY JON (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JON
Last Name:PULFER
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 1:1405 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5831
Mailing Address - Country:US
Mailing Address - Phone:260-482-4483
Mailing Address - Fax:260-471-9889
Practice Address - Street 1:1405 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5831
Practice Address - Country:US
Practice Address - Phone:260-482-4483
Practice Address - Fax:260-471-9889
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010676A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist