Active NPI
Lynnette Bradley
- Advanced Practice Dental Therapist
- Riverside, CA
National Provider Identifier
1033753298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Dental Therapist
- License
- HAP754
- Practice address
- 4218 Giles CT
Riverside, CA 92503-3154 - Phone
- (951) 314-5349
- NPI assigned
- Oct 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Dental Therapist | 125K00000X | HAP754 | CA | Primary |
Addresses
Primary practice location
4218 Giles CT
Riverside, CA 92503-3154
Mailing address
PO Box 7512
Riverside, CA 92513-7512
Phone (951) 314-5349
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HAP754 | CA | MD | Advanced Practice Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1033753298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7512",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925137512",
"telephone_number": "951-314-5349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4218 GILES CT",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925033154",
"telephone_number": "951-314-5349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "LYNNETTE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-31",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "125K00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Dental Therapist",
"state": "CA",
"license": "HAP754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.