Kelly Marie Bradley, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

7614 Issued in AZ

Practice address

1848 Hope Ave
Suite #2
Kingman, AZ 86401

Phone

(928) 753-5200

Fax

(928) 753-5205

NPI assigned

Jul 25, 2008

Sex

Female

Sole proprietor

Yes

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

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Family Dentistry by Design

  • General Practice Dentistry
  • Kingman, AZ
  • NPI 1982076097

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1447415799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 HOPE AVE",
            "address_2": "SUITE #2",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86401",
            "telephone_number": "928-753-5200",
            "fax_number": "928-753-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 HOPE AVE",
            "address_2": "SUITE #2",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "86401",
            "telephone_number": "928-753-5200",
            "fax_number": "928-753-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-25",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "7614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toby James Bowers, D.O.
• Ellen Louise Boyer, CRNA
• Jeffrey S Boyett, PA - C
• Joseph Aaron Bradbury, D.O.
• Braden Partners, LP
• Douglas W Brandt, MD
• Breathing Disorders Services
• Carol Marquis Breckenridge, LMSW
• Elisha Bremmer, D.O.
• Thomas Dee Bress, LISAC

• All providers in Kingman, AZ
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.