Provider Demographics
NPI:1700291408
Name:BRADFORD, BARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1857
Mailing Address - Country:US
Mailing Address - Phone:256-259-4411
Mailing Address - Fax:256-574-5653
Practice Address - Street 1:420 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-1857
Practice Address - Country:US
Practice Address - Phone:256-259-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD60981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice