Bradford J. Staph, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30414 Issued in CA

Practice address

30210 Rancho Viejo Rd
Suite B
San Juan Capistrano, CA 92675-1574

Phone

(949) 493-8118

NPI assigned

May 17, 2007

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

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780891630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30210 RANCHO VIEJO RD",
            "address_2": "SUITE B",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751574",
            "telephone_number": "949-493-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30210 RANCHO VIEJO RD",
            "address_2": "SUITE B",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751574",
            "telephone_number": "949-493-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAPH",
        "first_name": "BRADFORD",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garrett Todd Spencer, PT
• Spine and Sport Physical Therapy, Inc
• Sports Medicine Institute South Orange County
• St Cyril Inc (Camino Capistrano Pharmacy)
• Tiffany Chere Stacy, HIS
• Steven Stappaerts, MD
• Dianna Stark, LCSW
• Caroline Sue Statzula, RN
• Theresa Ann Steiner, MFTI
• Derrick Stephan, PA-C

• General Practice Dentistry in San Juan Capistrano, CA
• Providers in San Juan Capistrano, 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 8, 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.