Active NPI
Bradley R Daniel, DMD
- General Practice Dentistry
- Ellington, MO
National Provider Identifier
1316293145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2012024991
- Practice address
- 115 W Walnut St
Ellington, MO 63638-9300 - Phone
- (573) 663-3177
- Fax
- (573) 663-3188
- NPI assigned
- Jul 30, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2012024991 | MO | Primary |
Addresses
Primary practice location
115 W Walnut St
Ellington, MO 63638-9300
Mailing address
110 S 2ND St
Ellington, MO 63638-9400
Phone (573) 663-2313
Other practice location 1
315 W Mulberry Ste B
Pilot Knob, MO 63663-7883
Phone (573) 546-1001
Other practice location 2
101 E Batten Street
Naylor, MO 63953
Phone (573) 804-1779
Other practice location 3
1300 Victory Ln
Poplar Bluff, MO 63901-3300
Phone (573) 785-5566 ext. 17097
Other practice location 4
2300 Baugh Ln
Poplar Bluff, MO 63901-2402
Phone (573) 785-3037 ext. 16044
Other practice location 5
109 Plum St Ste D
Doniphan, MO 63935-1225
Phone (573) 351-2041
Other practice location 6
1407 N Westwood Blvd
Poplar Bluff, MO 63901-3315
Phone (573) 778-3042
Other practice location 7
1 Hals Plz Ste B
Piedmont, MO 63957-1631
Phone (573) 223-8902
Other practice location 8
603 E Summit St
Doniphan, MO 63935-1142
Phone (573) 996-3667 ext. 1117
Other practice location 9
11001 US-160
Harviell, MO 63945
Phone (573) 804-9561
Other practice location 10
711 Nickey St
Poplar Bluff, MO 63901-6544
Phone (573) 785-7047 ext. 13040
Other practice location 11
3277 US Highway 160 W
Doniphan, MO 63935-5710
Phone (573) 804-9527
Other practice location 12
289 Broadway St
Neelyville, MO 63954-7176
Phone (573) 804-9494
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 |
|---|---|---|---|
| 2012024991 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788048000000",
"number": "1316293145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 S 2ND ST",
"city": "ELLINGTON",
"state": "MO",
"postal_code": "636389400",
"telephone_number": "573-663-2313",
"fax_number": "573-663-2441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 W WALNUT ST",
"city": "ELLINGTON",
"state": "MO",
"postal_code": "636389300",
"telephone_number": "573-663-3177",
"fax_number": "573-663-3188"
}
],
"practiceLocations": [
{
"address_1": "315 W Mulberry Ste B",
"address_purpose": "LOCATION",
"city": "Pilot Knob",
"state": "MO",
"postal_code": "636637883",
"country_code": "US",
"telephone_number": "573-546-1001",
"fax_number": "573-546-1002",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "101 E Batten Street",
"address_purpose": "LOCATION",
"city": "Naylor",
"state": "MO",
"postal_code": "63953",
"country_code": "US",
"telephone_number": "573-804-1779",
"fax_number": "573-804-1789",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1300 Victory Ln",
"address_purpose": "LOCATION",
"city": "Poplar Bluff",
"state": "MO",
"postal_code": "639013300",
"country_code": "US",
"telephone_number": "573-785-5566 x17097",
"fax_number": "573-413-4194",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2300 Baugh Ln",
"address_purpose": "LOCATION",
"city": "Poplar Bluff",
"state": "MO",
"postal_code": "639012402",
"country_code": "US",
"telephone_number": "573-785-3037 x16044",
"fax_number": "573-413-4506",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "109 Plum St Ste D",
"address_purpose": "LOCATION",
"city": "Doniphan",
"state": "MO",
"postal_code": "639351225",
"country_code": "US",
"telephone_number": "573-351-2041",
"fax_number": "573-351-2016",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1407 N Westwood Blvd",
"address_purpose": "LOCATION",
"city": "Poplar Bluff",
"state": "MO",
"postal_code": "639013315",
"country_code": "US",
"telephone_number": "573-778-3042",
"fax_number": "573-778-9432",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Hals Plz Ste B",
"address_purpose": "LOCATION",
"city": "Piedmont",
"state": "MO",
"postal_code": "639571631",
"country_code": "US",
"telephone_number": "573-223-8902",
"fax_number": "573-223-2141",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "603 E Summit St",
"address_purpose": "LOCATION",
"city": "Doniphan",
"state": "MO",
"postal_code": "639351142",
"country_code": "US",
"telephone_number": "573-996-3667 x1117",
"fax_number": "573-413-4487",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11001 US-160",
"address_purpose": "LOCATION",
"city": "Harviell",
"state": "MO",
"postal_code": "63945",
"country_code": "US",
"telephone_number": "573-804-9561",
"fax_number": "573-804-9581",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "711 Nickey St",
"address_purpose": "LOCATION",
"city": "Poplar Bluff",
"state": "MO",
"postal_code": "639016544",
"country_code": "US",
"telephone_number": "573-785-7047 x13040",
"fax_number": "573-413-4192",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3277 US Highway 160 W",
"address_purpose": "LOCATION",
"city": "Doniphan",
"state": "MO",
"postal_code": "639355710",
"country_code": "US",
"telephone_number": "573-804-9527",
"fax_number": "573-804-9536",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "289 Broadway St",
"address_purpose": "LOCATION",
"city": "Neelyville",
"state": "MO",
"postal_code": "639547176",
"country_code": "US",
"telephone_number": "573-804-9494",
"fax_number": "573-804-9493",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DANIEL",
"first_name": "BRADLEY",
"middle_name": "R",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-30",
"last_updated": "2026-08-30",
"certification_date": "2026-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2012024991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.