Provider Demographics
NPI:1275630121
Name:IRVING, BRADLEY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALLEN
Last Name:IRVING
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 1:75 CORTE YOLANDA
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1625
Mailing Address - Country:US
Mailing Address - Phone:925-283-6723
Mailing Address - Fax:510-339-1021
Practice Address - Street 1:6116 MERCED AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2917
Practice Address - Country:US
Practice Address - Phone:510-339-1250
Practice Address - Fax:510-339-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics