Provider Demographics
NPI:1790005932
Name:DURHAM, BRADFORD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:A
Last Name:DURHAM
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 1:1317 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
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice