Jaclyn Bradle, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

61315 Issued in CA

Practice address

8639 1/2 Baseline Rd
Rancho Cucamonga, CA 91730-1111

Phone

(909) 989-4709

NPI assigned

May 21, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Marquez Former name

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

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jbradle@direct.westerndental.com

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.

• Jaclyn Bradle DDS Inc.

  • General Practice Dentistry
  • Rancho Cucamonga, CA
  • NPI 1891105540
  NPD (past) Authorized official

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1891055109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8639 1/2 BASELINE RD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301111",
            "telephone_number": "909-989-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8639 1/2 BASELINE RD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301111",
            "telephone_number": "909-989-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLE",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-21",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "61315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "MARQUEZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelley Marie Boyer, PTA
• Aruna Prabha Boyineni
• Bqute Enterprises
• Jacquelyn J. Bradbard, MSW, LCSW
• Hana Bradford
• Brain Psychiatry Inc
• Susan K Brainard, O.T.
• Rachel Bramer
• Fatima Brammer
• Courtney Brandon

• General Practice Dentistry in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, 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 Jan 29, 2015; 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.