Brent J. Bradley, D.D.S
Individual provider Active NPI Pediatric Dentistry · Rapid City, SD
NPI 1124088166 · NPPES record last updated Aug 28, 2007
Key facts
- NPI
- 1124088166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- M864 (SD)
- Practice address
- 700 Sheridan Lake Rd
Rapid City, SD 57702-2407 - Phone
- (605) 341-3068
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M864 | SD | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black Hills Pediatric Dentistry | Pediatric Dentistry | Past |
Accepting new patients |
| Black Hills Pediatric Dentistry | Pediatric Dentistry | Past | Accepting new patients |
| Rushmore Ambulatory Surgery Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | M864 | SD | Yes |
Addresses
Primary practice location
700 Sheridan Lake Rd
Rapid City, SD 57702-2407
Mailing address
700 Sheridan Lake Rd
Rapid City, SD 57702-2407
Phone (605) 341-3068
Other providers in Rapid City, SD
- Stacey Boyd
- Tiara Jean Boyer
- Diana Boyle
- Kathleen A Boyle
- Brad Moriarty OD PC
- Heather R Bradley
- Kierstin Elizabeth Bradley
- Mikayla Bradley
- Shari Lynn Bradstream
- Danielle Rose Brady
All providers in Rapid City, SD · Pediatric Dentistry in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.