Provider Demographics
NPI:1326487737
Name:CROSSFIELD, BRADLEY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RAY
Last Name:CROSSFIELD
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 1:1001 S BOWMAN ROAD
Mailing Address - Street 2:STE 1
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-222-9101
Mailing Address - Fax:
Practice Address - Street 1:1001 S BOWMAN ROAD
Practice Address - Street 2:STE 1
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-222-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3923122300000X, 1223P0221X
TX307731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist