NPIMap

Organization Active NPI

Damon G Bradford DDS LTD

  • Periodontics
  • Monroe, LA
National Provider Identifier
1144343906
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
DAMON G BRADFORD DDS LTD
Practice address
2005 Forsythe Ave
Monroe, LA 71201
Phone
(318) 388-2630
Fax
(318) 322-4537
NPI assigned
Apr 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Lila C Walimaa
Title
Bookkeeper Secretary
Phone
(318) 388-2630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X Primary

Addresses

Primary practice location

2005 Forsythe Ave
Monroe, LA 71201

Mailing address

2005 Forsythe Ave
Monroe, LA 71201
Phone (318) 388-2630

Other names 1

  • Dental Specialty Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144343906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-388-2630",
            "fax_number": "318-322-4537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-388-2630",
            "fax_number": "318-322-4537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMON G BRADFORD DDS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALIMAA",
        "authorized_official_first_name": "LILA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BOOKKEEPER SECRETARY",
        "authorized_official_telephone_number": "318-388-2630",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Specialty",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.