Provider Demographics
NPI:1073058228
Name:BRADFORD, PAMELA SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SMITH
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 SQUIRREL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1146
Mailing Address - Country:US
Mailing Address - Phone:248-505-9258
Mailing Address - Fax:
Practice Address - Street 1:1326 SAINT ANTOINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2301
Practice Address - Country:US
Practice Address - Phone:248-505-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist