Bradley Thain Porter, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4124 Issued in AZ

Practice address

6755 E Superstition Springs Blvd
Suite 103
Mesa, AZ 85206-4373

Phone

(480) 830-5866

Fax

(480) 807-0606

NPI assigned

Dec 23, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 11, 2016 through May 11, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Maxillofacial Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mesa, AZ
  • NPI 1932132651
  NPD (past)
• Az Max Surgeons PLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mesa, AZ
  • NPI 1528530284
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1023095734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "SUITE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-830-5866",
            "fax_number": "480-807-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6755 E SUPERSTITION SPRINGS BLVD",
            "address_2": "SUITE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064373",
            "telephone_number": "480-830-5866",
            "fax_number": "480-807-0606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18610 E Rittenhouse Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Queen Creek",
            "state": "AZ",
            "postal_code": "851424504",
            "country_code": "US",
            "telephone_number": "480-830-5866",
            "fax_number": "480-807-0606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "BRADLEY",
        "middle_name": "THAIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "4124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173766",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0482170",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody Pope
• Nicholas Poplin
• Phyllis I Popp, DO
• Diane Harvey Porritt, M.S.P.T.
• Andrew Porter, PA-C
• David Porter, LCSW
• Doran Porter, DPT
• Jason Alan Porter, NMD
• Maurice Antonio Porter
• Michael James Porter, PA-C

• Oral and Maxillofacial Surgery (Dentist) in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.