Provider Demographics
NPI:1285839761
Name:BRADFORD, ROBERT FRANK JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANK
Last Name:BRADFORD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 HIGHWAY 31 UNIT B
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5165
Mailing Address - Country:US
Mailing Address - Phone:334-467-6095
Mailing Address - Fax:
Practice Address - Street 1:5075 HWY 31 UNIT B,
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040
Practice Address - Country:US
Practice Address - Phone:334-467-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPENDING1223G0001X
AL55371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115210Medicaid