Provider Demographics
NPI:1487439733
Name:LANDER, BRADLEY (MCHD/BCHD, MS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:LANDER
Suffix:
Gender:M
Credentials:MCHD/BCHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E WACKER PLACE
Mailing Address - Street 2:APARTMENT 3705
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:201-724-0381
Mailing Address - Fax:
Practice Address - Street 1:223 JACKSON BLVD
Practice Address - Street 2:SUITE #1275
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:201-724-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist