Provider Demographics
NPI:1538507975
Name:WASHINGTON, BRADFORD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:C
Last Name:WASHINGTON
Suffix:
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 1:1851 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3634
Mailing Address - Country:US
Mailing Address - Phone:212-866-9800
Mailing Address - Fax:212-866-9801
Practice Address - Street 1:1851 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3634
Practice Address - Country:US
Practice Address - Phone:212-866-9800
Practice Address - Fax:212-866-9801
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0565981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03610515Medicaid