Individual provider Active NPI

Bradley Scott Matthew, D.D.S

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1922166354
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48510 Issued in CA
Practice address
8540 S Sepulveda Blvd
#808
Los Angeles, CA 90045-3807
Phone
(310) 670-0659
Fax
(310) 670-6880
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 48510 CA Primary

Addresses

Primary practice location

8540 S Sepulveda Blvd
#808
Los Angeles, CA 90045-3807

Mailing address

2050 S Bentley Ave
#303
Los Angeles, CA 90025-5661
Phone (310) 914-4904

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
48510CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922166354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BENTLEY AVE",
            "address_2": "#303",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255661",
            "telephone_number": "310-914-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8540 S SEPULVEDA BLVD",
            "address_2": "#808",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453807",
            "telephone_number": "310-670-0659",
            "fax_number": "310-670-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEW",
        "first_name": "BRADLEY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.