Provider Demographics
NPI:1689028300
Name:BRADFORD A. DURHAM DMD, PC
Entity Type:Organization
Organization Name:BRADFORD A. DURHAM DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-234-8282
Mailing Address - Street 1:1317 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6939
Mailing Address - Country:US
Mailing Address - Phone:912-234-8282
Mailing Address - Fax:912-232-7925
Practice Address - Street 1:1317 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6939
Practice Address - Country:US
Practice Address - Phone:912-234-8282
Practice Address - Fax:912-232-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty