Active NPI
Bradford Timothy Davis, D.D.S.
- General Practice Dentistry
- Opelousas, LA
National Provider Identifier
1609948322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3626
- Practice address
- 921 N Union St
Opelousas, LA 70570-6407 - Phone
- (337) 942-5122
- Fax
- (337) 942-5122
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 3626 | LA | Primary |
Addresses
Primary practice location
921 N Union St
Opelousas, LA 70570-6407
Mailing address
921 N Union St
Opelousas, LA 70570-6407
Phone (337) 942-5122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1836265 | Medicaid | LA |
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 |
|---|---|---|---|
| 3626 | LA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1609948322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 N UNION ST",
"city": "OPELOUSAS",
"state": "LA",
"postal_code": "705706407",
"telephone_number": "337-942-5122",
"fax_number": "337-942-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 N UNION ST",
"city": "OPELOUSAS",
"state": "LA",
"postal_code": "705706407",
"telephone_number": "337-942-5122",
"fax_number": "337-942-5122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "BRADFORD",
"middle_name": "TIMOTHY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "3626",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1836265",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Opelousas, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.