Provider Demographics
NPI:1942204714
Name:KAUFMAN, BRADLEY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:KAUFMAN
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 1:925 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1409
Mailing Address - Country:US
Mailing Address - Phone:585-424-6400
Mailing Address - Fax:585-424-6426
Practice Address - Street 1:925 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1409
Practice Address - Country:US
Practice Address - Phone:585-424-6400
Practice Address - Fax:585-424-6426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70385OtherEXCELLUS BLUE SHIELD