Provider Demographics
NPI:1801262530
Name:STORRS, BRADLEY PAUL (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:PAUL
Last Name:STORRS
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 1:69 LONDON DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-1913
Mailing Address - Country:US
Mailing Address - Phone:720-233-7368
Mailing Address - Fax:
Practice Address - Street 1:6837 NORMANDY RD BLDG B
Practice Address - Street 2:ATTN: CHARLES BERNATOVITZ
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150202801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery