Provider Demographics
NPI:1780838508
Name:ARMSTRONG, BRADFORD A (DMD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:A
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9191
Mailing Address - Country:US
Mailing Address - Phone:601-856-3141
Mailing Address - Fax:601-856-1522
Practice Address - Street 1:459 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9191
Practice Address - Country:US
Practice Address - Phone:601-856-3141
Practice Address - Fax:601-856-1522
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2327-871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice