Provider Demographics
NPI:1558419945
Name:BRADFORD, PHILIP A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:BRADFORD
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 1:8151 ARLINGTON AVE STE U-V
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0436
Mailing Address - Country:US
Mailing Address - Phone:951-588-0861
Mailing Address - Fax:951-588-1910
Practice Address - Street 1:1970 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5202
Practice Address - Country:US
Practice Address - Phone:951-276-0668
Practice Address - Fax:951-328-9578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice