Provider Demographics
NPI:1275552523
Name:SMITH, BRADFORD PEIARS (DMD, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:PEIARS
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 36TH ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4851
Mailing Address - Country:US
Mailing Address - Phone:772-567-6527
Mailing Address - Fax:772-567-6703
Practice Address - Street 1:1710 36TH ST
Practice Address - Street 2:BLDG B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4851
Practice Address - Country:US
Practice Address - Phone:772-567-6527
Practice Address - Fax:772-567-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0129701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics