Provider Demographics
NPI:1487659751
Name:HART, BRAD LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:LAWRENCE
Last Name:HART
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 1:1785 SAN CARLOS AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2026
Mailing Address - Country:US
Mailing Address - Phone:650-593-7806
Mailing Address - Fax:650-593-6585
Practice Address - Street 1:1785 SAN CARLOS AVE
Practice Address - Street 2:STE 1
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2026
Practice Address - Country:US
Practice Address - Phone:650-593-7806
Practice Address - Fax:650-593-6585
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice