Provider Demographics
NPI:1962510610
Name:BENDUSH, BRADLEY RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RAYMOND
Last Name:BENDUSH
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 1:115 N SHORTRIDGE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4908
Mailing Address - Country:US
Mailing Address - Phone:317-353-1062
Mailing Address - Fax:317-357-5999
Practice Address - Street 1:115 N SHORTRIDGE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4908
Practice Address - Country:US
Practice Address - Phone:317-353-1062
Practice Address - Fax:317-357-5999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8546OtherINDIANA