Provider Demographics
NPI:1134381940
Name:HUME, BRADLEY THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:THOMAS
Last Name:HUME
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 1:317 7TH ST. W.
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5206
Mailing Address - Country:US
Mailing Address - Phone:941-729-6883
Mailing Address - Fax:
Practice Address - Street 1:317 7TH ST. W.
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5206
Practice Address - Country:US
Practice Address - Phone:941-729-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQA018GP5Medicaid