Provider Demographics
NPI:1770554867
Name:HAJDIK, BRADLEY HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:HOWARD
Last Name:HAJDIK
Suffix:
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:PSC 819 BOX 18-313
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0313
Mailing Address - Country:US
Mailing Address - Phone:3495-648-0879
Mailing Address - Fax:
Practice Address - Street 1:PSC 819 BOX 18-313
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0313
Practice Address - Country:US
Practice Address - Phone:3495-648-0879
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics