Provider Demographics
NPI:1205053188
Name:BRADFORD, HANK (DMD)
Entity type:Individual
Prefix:DR
First Name:HANK
Middle Name:
Last Name:BRADFORD
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 1:3535 ROSWELL RD
Mailing Address - Street 2:SUITE 46
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8826
Mailing Address - Country:US
Mailing Address - Phone:678-560-4100
Mailing Address - Fax:678-560-4149
Practice Address - Street 1:3535 ROSWELL RD
Practice Address - Street 2:SUITE 46
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8826
Practice Address - Country:US
Practice Address - Phone:678-560-4100
Practice Address - Fax:678-560-4149
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics