| NPI | 1629172812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LEWIS BRADLEY Owner/Dentist 252-482-1080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5267) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2020-08-22 |