Provider Demographics
NPI:1952733800
Name:PATRICK BRADLEY, DDS, PLLC
Entity Type:Organization
Organization Name:PATRICK BRADLEY, DDS, PLLC
Other - Org Name:SPOKANE PEDIATRIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:CONNOR
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-315-3200
Mailing Address - Street 1:6821 N COUNTRY HOMES BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4372
Mailing Address - Country:US
Mailing Address - Phone:509-315-3200
Mailing Address - Fax:
Practice Address - Street 1:6821 N COUNTRY HOMES BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4372
Practice Address - Country:US
Practice Address - Phone:509-315-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60378580261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental