Individual provider Active NPI

Bradley Seago, DDS

  • Dentist
  • Grand Junction, CO
National Provider Identifier
1578884094
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10539 Issued in CO
Practice address
2333 N 6TH St
Medical Education
Grand Junction, CO 81501-2001
Phone
(970) 298-7821
Fax
(970) 298-1726
NPI assigned
Jun 18, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10539 CO Primary

Addresses

Primary practice location

2333 N 6TH St
Medical Education
Grand Junction, CO 81501-2001

Mailing address

2333 N 6TH St
Medical Education
Grand Junction, CO 81501-2001
Phone (970) 298-7821

Other identifiers 1

IdentifierTypeStateIssuer
68003340MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20151230001193 CO Practitioner - Oral Surgery 7719289255 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10539COMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Marillac Clinic, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Marillac Clinic, Inc. CurrentSince Dec 1, 2015 Accepting new patients

Locations

2333 N 6th St
Grand Junction, CO 81501
Phone (970) 298-1782

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1578884094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 N 6TH ST",
            "address_2": "MEDICAL EDUCATION",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012001",
            "telephone_number": "970-298-7821",
            "fax_number": "970-298-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 N 6TH ST",
            "address_2": "MEDICAL EDUCATION",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012001",
            "telephone_number": "970-298-7821",
            "fax_number": "970-298-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEAGO",
        "first_name": "BRADLEY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-18",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "10539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68003340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.