Provider Demographics
NPI:1134733876
Name:BRADLEY R CROSSFIELD DDS PLLC
Entity type:Organization
Organization Name:BRADLEY R CROSSFIELD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CROSSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-951-0031
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-0677
Mailing Address - Country:US
Mailing Address - Phone:501-951-0031
Mailing Address - Fax:
Practice Address - Street 1:880 EAST CENTERTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719
Practice Address - Country:US
Practice Address - Phone:501-951-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental