Active NPI
Kathleen K Bradley, DDS
- Pediatric Dentistry
- Indianapolis, IN
National Provider Identifier
1306853734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12010981A
- Practice address
- 6443 W 10TH St Ste 204
Indianapolis, IN 46214-6502 - Phone
- (317) 247-9512
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 12010981A | IN | Primary |
Addresses
Primary practice location
6443 W 10TH St Ste 204
Indianapolis, IN 46214-6502
Mailing address
6443 W 10TH St Ste 204
Indianapolis, IN 46214-6502
Phone (317) 247-9512
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 |
|---|---|---|---|
| 12010981A | IN | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560556800000",
"number": "1306853734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6443 W 10TH ST STE 204",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462146502",
"telephone_number": "317-247-9512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6443 W 10TH ST STE 204",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462146502",
"telephone_number": "317-247-9512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "KATHLEEN",
"middle_name": "K",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2019-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "12010981A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.