Mark Larsen Bradford, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36646 Issued in CA

Practice address

2545 Ceanothus Ave
Ste 138
Chico, CA 95973-7611

Phone

(530) 342-7974

NPI assigned

Jun 1, 2005

Sex

Male

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 CA

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

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1477555613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 CEANOTHUS AVE",
            "address_2": "STE 138",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959737611",
            "telephone_number": "530-342-7974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 CEANOTHUS AVE",
            "address_2": "STE 138",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959737611",
            "telephone_number": "530-342-7974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "MARK",
        "middle_name": "LARSEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karma Jennifer Boyer, PT, DPT, COMT
• Cory D Boyles, MD
• Jamie Ann Bracewell, BSN, RNC-OB, IBCLC
• Eleanor Nmi Bradbury, NURSE PRACTITIONER
• Braden Partners, L.P.
• Annabelle Korae Bradley, MSW
• Laurie B Bradshaw, NP
• Krista Jean Brady
• Tonia Marie Braemer, R.N.
• Teresa Mae Brake, LVN

• General Practice Dentistry in Chico, CA
• Providers in Chico, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.