Provider Demographics
NPI:1891709374
Name:LAGERS, BRADLEY JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOHN
Last Name:LAGERS
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 1:4845 E THUNDERBIRD RD
Mailing Address - Street 2:STE 3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3539
Mailing Address - Country:US
Mailing Address - Phone:602-996-1660
Mailing Address - Fax:602-996-2321
Practice Address - Street 1:4845 E THUNDERBIRD RD
Practice Address - Street 2:STE 3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3539
Practice Address - Country:US
Practice Address - Phone:602-996-1660
Practice Address - Fax:602-996-2321
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist