Provider Demographics
NPI:1154546869
Name:BRADLEY, RICHARD BENJAMIN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BENJAMIN
Last Name:BRADLEY
Suffix:JR
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 1:187 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558
Mailing Address - Country:US
Mailing Address - Phone:434-476-7885
Mailing Address - Fax:
Practice Address - Street 1:187 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558
Practice Address - Country:US
Practice Address - Phone:434-476-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice