Bradley Alexander Deckelman, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4619 Issued in AR

Practice address

2302 N Reynolds Rd
Bryant, AR 72022-2536

Phone

(501) 481-4763

NPI assigned

Jun 29, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Eric Sharks DDS PLLC

  • General Practice Dentistry
  • Bryant, AR
  • NPI 1033565445
  NPD (past)

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

{
    "created_epoch": "1656460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1851023717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 N REYNOLDS RD",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720222536",
            "telephone_number": "501-481-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 N REYNOLDS RD",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720222536",
            "telephone_number": "501-481-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKELMAN",
        "first_name": "BRADLEY",
        "middle_name": "ALEXANDER",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-29",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "4619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Davis
• Evan Christopher Davis, DDS
• Samantha Lee Davis, M.ED, BCBA
• Dawn Lindsey DNP, Aprn PLLC
• Sarah Dean, OTD, OTR/L
• Estrella Delacruz
• Justina Louise Delong
• Taeitha Eve Demery
• Carol R. Dennis, B. S., R. D. H.
• Darshankumar Desai, PHARMD

• General Practice Dentistry in Bryant, AR
• Providers in Bryant, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.