Provider Demographics
NPI:1700086170
Name:DELPH, BRADLEY GENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GENE
Last Name:DELPH
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 1:306 N 26TH ST
Mailing Address - Street 2:UNIT 220
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7264
Mailing Address - Country:US
Mailing Address - Phone:201-344-0587
Mailing Address - Fax:
Practice Address - Street 1:628 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181
Practice Address - Country:US
Practice Address - Phone:804-843-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice