Active NPI
Ryan Bradley, DMD
- Dentist
- Bentonville, AR
National Provider Identifier
1831641877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4464
- Practice address
- 104 S Walton Blvd
Bentonville, AR 72712-5747 - Phone
- (479) 273-3757
- NPI assigned
- Oct 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 32495 | TX | |
| Dentist | 122300000X | 4464 | AR | Primary |
Addresses
Primary practice location
104 S Walton Blvd
Bentonville, AR 72712-5747
Mailing address
1201 SW Willow Bend Ave
Bentonville, AR 72713-7977
Phone (630) 696-0000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rbradley@riverdentalar.com |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4464 | AR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roberts and Criswell DDS PA | Past | Accepting new patients | |
| Walton Dental, PLLC | Past | Accepting new patients |
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.
-
- General Practice Dentistry
- Bentonville, AR
- NPI 1114326832
-
- General Practice Dentistry
- Bentonville, AR
- NPI 1427519669
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609372800000",
"number": "1831641877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 SW WILLOW BEND AVE",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727137977",
"telephone_number": "630-696-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S WALTON BLVD",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727125747",
"telephone_number": "479-273-3757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "RYAN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-25",
"last_updated": "2020-12-31",
"certification_date": "2020-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "32495",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "4464",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rbradley@riverdentalar.com",
"affiliation": "N",
"endpointDescription": "My business email",
"address_1": "3500 Black Forest Dr Ste 1",
"city": "Fayetteville",
"state": "AR",
"country_code": "US",
"postal_code": "727046551",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.