BRADLEY RANDALL CONGLETON

LOUISVILLE, KY
NPI1952754749
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1223D0001X Dentist, Dental Public Health
(Licence: KY  9824)
Additional Taxonomies122300000X Dentist
(Licence: IN  12014346A)
1223G0001X Dentist, General Practice
(Licence: KY  9824)
Enumeration Date2016-07-18
Last Update Date2024-11-18
Business Address
BRADLEY RANDALL CONGLETON DMD
2215 PORTLAND AVE
LOUISVILLE, KY 40212-1033
Phone number: 502-774-8631
Mailing Address
BRADLEY RANDALL CONGLETON DMD
PO BOX 950244
LOUISVILLE, KY 40295-0244
Phone number: 502-772-8160