Provider Demographics
NPI:1588680268
Name:HAMMOND, BRADLEY TAYLER (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:TAYLER
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15566 N 177TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3101
Mailing Address - Country:US
Mailing Address - Phone:623-328-8505
Mailing Address - Fax:
Practice Address - Street 1:16936 W BELL RD STE 203
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8949
Practice Address - Country:US
Practice Address - Phone:623-583-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery