Lise Bradley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

040056-1 Issued in NY

Practice address

1201 Troy Schenectady Rd
Latham, NY 12110-1028

Phone

(518) 785-3084

Fax

(518) 785-0243

NPI assigned

Dec 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Capital Area Hudson Valley New York Dental, PC

  • Dentist
  • Latham, NY
  • NPI 1790857944
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326100397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SARATOGA VILLAGE BLVD",
            "address_2": "STE 36A",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120203737",
            "telephone_number": "518-899-9783",
            "fax_number": "518-899-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121101028",
            "telephone_number": "518-785-3084",
            "fax_number": "518-785-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "LISE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "040056-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi F Bloch, LCSW
• Marlis Yvonne Bouchard-Nichols, OTR/L
• Maria Boulos
• Diane A Bourke, M.D.
• Joseph Anthony Bova, D.C., D.A.C.N.B.
• Ian Thomas Brady
• Alexander C Brand, M.D.
• Olivia Lauren Bransky, FNP-C
• Lanessa Renee Brant, NURSE PRACTITIONER
• Gayla Brasel, LMHC

• General Practice Dentistry in Latham, NY
• Providers in Latham, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.