Provider Demographics
NPI:1245347046
Name:BILLS, BRADLEY POPE (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:POPE
Last Name:BILLS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 N MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1550
Mailing Address - Country:US
Mailing Address - Phone:435-787-4444
Mailing Address - Fax:435-787-0044
Practice Address - Street 1:3125 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1550
Practice Address - Country:US
Practice Address - Phone:435-787-4444
Practice Address - Fax:435-787-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1449681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice