Provider Demographics
NPI:1932137825
Name:TROTTER, BRADLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:TROTTER
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 1:11971 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1458
Mailing Address - Country:US
Mailing Address - Phone:804-717-5275
Mailing Address - Fax:804-748-4017
Practice Address - Street 1:11971 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1458
Practice Address - Country:US
Practice Address - Phone:804-717-5275
Practice Address - Fax:804-748-4017
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
01363855OtherUNITED CONCORDIA
219900OtherANTHEM BCBS
259641OtherANTHEM BCBS
219899OtherANTHEM BCBS
219899OtherANTHEM BCBS