Provider Demographics
NPI:1932652344
Name:CUMMINGS, BRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:CUMMINGS
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 1:2401 SAN MARCO LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2354
Mailing Address - Country:US
Mailing Address - Phone:909-747-9482
Mailing Address - Fax:
Practice Address - Street 1:6400 SW 3RD ST
Practice Address - Street 2:STE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-2206
Practice Address - Country:US
Practice Address - Phone:405-458-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005841223G0001X
OK68931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice