Basic Information
| Provider Information | |||||||||
| NPI: | 1801262530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STORRS | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 LONDON DR | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283071913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202337368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6837 NORMANDY RD BLDG B | ||||||||
| Address2: | ATTN: CHARLES BERNATOVITZ | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106432196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 2015020280 | MO | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.