Provider Demographics
NPI:1831118116
Name:HEATH, BRADFORD ALEX (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:ALEX
Last Name:HEATH
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 1:1939 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2525
Mailing Address - Country:US
Mailing Address - Phone:925-689-0516
Mailing Address - Fax:
Practice Address - Street 1:1939 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2525
Practice Address - Country:US
Practice Address - Phone:925-689-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0365541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice