Provider Demographics
NPI:1922387240
Name:MCALLISTER, BRADLEY (DDS,PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:DDS,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 SW DURHAM RD
Mailing Address - Street 2:STE. D-6
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3475
Mailing Address - Country:US
Mailing Address - Phone:503-620-2807
Mailing Address - Fax:503-968-5419
Practice Address - Street 1:11525 SW DURHAM RD
Practice Address - Street 2:STE. D-6
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3475
Practice Address - Country:US
Practice Address - Phone:503-620-2807
Practice Address - Fax:503-968-5419
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics