Provider Demographics
NPI:1205290681
Name:SKELTON, BRADLEY PATRICK (DMD)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:PATRICK
Last Name:SKELTON
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 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 2006
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4641
Mailing Address - Fax:513-636-8283
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:DIVISION OF PEDIATRIC DENTISTRY, ML 2006
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4641
Practice Address - Fax:513-636-8283
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0247801223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice