Provider Demographics
NPI:1356403836
Name:BRADFORD, JAMES S (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:BRADFORD
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 1:10199 W L AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9325
Mailing Address - Country:US
Mailing Address - Phone:269-323-3311
Mailing Address - Fax:269-323-0162
Practice Address - Street 1:710 WEST CENTRE AVENUE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-323-3311
Practice Address - Fax:269-323-0162
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist