Provider Demographics
NPI:1861485997
Name:MCKEEVER, BRADLEY GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GEORGE
Last Name:MCKEEVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE AMISTAD
Mailing Address - Street 2:# 3304
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6917
Mailing Address - Country:US
Mailing Address - Phone:949-492-1102
Mailing Address - Fax:
Practice Address - Street 1:1ST DENTAL BN, 1ST DENCO
Practice Address - Street 2:SOI BASILONE RD.
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-7704
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022723-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics