Provider Demographics
NPI:1376655779
Name:BEDFORD, DONALD BREVARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BREVARD
Last Name:BEDFORD
Suffix:JR
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 1:831 LANDA ST
Mailing Address - Street 2:STE D
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-625-7757
Mailing Address - Fax:830-625-7767
Practice Address - Street 1:831 LANDA ST
Practice Address - Street 2:STE D
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-625-7757
Practice Address - Fax:830-625-7767
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist