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1114052966
BRADLEY J CLARK
BROKEN BOW, NE
NPI
1114052966
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: NE 6126)
Enumeration Date
2007-02-22
Last Update Date
2007-07-08
Business Address
Dr. BRADLEY J CLARK DDS
310 S 9TH AVE
BROKEN BOW, NE 68822-2014
Phone number: 308-872-2575
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Mailing Address
Dr. BRADLEY J CLARK DDS
PO BOX 117 310 SOUTH 9TH AVE.
BROKEN BOW, NE 68822-0117
Phone number: 308-872-2575
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