Active NPI
Bradley Jon Pulfer, D.D.S.
- Dentist
- Fort Wayne, IN
National Provider Identifier
1851571301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12010676A
- Practice address
- 1405 Medical Park Dr
Fort Wayne, IN 46825-5831 - Phone
- (260) 482-4483
- Fax
- (260) 471-9889
- NPI assigned
- Nov 13, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12010676A | IN | Primary |
Addresses
Primary practice location
1405 Medical Park Dr
Fort Wayne, IN 46825-5831
Mailing address
1405 Medical Park Dr
Fort Wayne, IN 46825-5831
Phone (260) 482-4483
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150505000522 | IN | Order and Referring Only - Other (Non-Physician) | 9830418383 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215475200000",
"number": "1851571301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 MEDICAL PARK DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255831",
"telephone_number": "260-482-4483",
"fax_number": "260-471-9889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 MEDICAL PARK DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255831",
"telephone_number": "260-482-4483",
"fax_number": "260-471-9889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULFER",
"first_name": "BRADLEY",
"middle_name": "JON",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-13",
"last_updated": "2008-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12010676A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
- Gisella P Puga, CRNA
- Pulaski Memorial Hospital (Majestic Care of Fort Wayne)
- Pulaski Memorial Hospital (Majestic Care of West Allen)
- Pulaski Memorial Hospital (Majestic Care of Jefferson Pointe)
- Pulaski Memorial Hospital (Kingston Care Center of Fort Wayne)
- Sheryleen Derede Pulfer, D.D.S
- Jyostna Deepika Pulla, MD
- Niyota Pulliam
- Pulmonary Asthma & Allergy Consults
- Diedre Pulver, RD, LD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.