Jerry Bradley DDS and Associates PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5267 Issued in NC

Legal business name

JERRY BRADLEY DDS AND ASSOCIATES PLLC

Practice address

512 Coke Ave
Edenton, NC 27932-1539

Phone

(252) 482-1080

Fax

(252) 482-1082

NPI assigned

Sep 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Lewis Bradley, DDSNPI 1184713505

Title

Owner/Dentist

Phone

(252) 482-1080

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry L Bradley, DDS

  • Dentist
  • Edenton, NC
  • NPI 1184713505
  NPD (past) Authorized official
• Jalisa B. Parrish, DDS

  • General Practice Dentistry
  • Edenton, NC
  • NPI 1275986846
  NPD (past)

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629172812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 552",
            "address_2": "512 COKE AVENUE",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279320552",
            "telephone_number": "252-482-1080",
            "fax_number": "252-482-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 COKE AVE",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321539",
            "telephone_number": "252-482-1080",
            "fax_number": "252-482-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY BRADLEY DDS AND ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "252-482-1080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7990844",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaffer Hussain, M.D.
• Inner Banks Psychiatry, PLLC
• Integrated Family Services, PLLC
• Interim Healthcare - Morris Group Inc
• Interim Healthcare - Morris Group Inc
• JL Masterlife Inc.
• Susan Jones, PTA
• Jean Claude Jubert, DO
• Valerie Ann Kaplan, RN
• Kats Kids

• General Practice Dentistry in Edenton, NC
• Providers in Edenton, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.