Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5346802-9921 | UT |
Y | 1223X0400X | Orthodontists | 27494 | TX |
NPI | 1053532606 |
---|---|
Provider Name | Dr. Bradley Jay Pierson |
First Address | San Antonio, TX 78249-3980 |
Second Address | San Antonio, TX 78249-3980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 25/06/2019 |