Dr. Bradley Glenn Fawcett, DDS
Dentist, General Practice in Indianapolis, IN. Individual provider (NPI-1).
NPI number1023181237
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1023181237
- Entity type
- Individual (NPI-1)
- Name
- Dr. Bradley Glenn Fawcett
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 16, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 12009858 | IN | Yes |
Practice location
2440 Lake Circle DrIndianapolis, IN 46268-4219
Phone 317-872-0800 · Fax 317-872-1224
Mailing address
2440 Lake Circle DrIndianapolis, IN 46268-4219
Phone 317-872-0800 · Fax 317-872-1224
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