Bradley McAllister, DDS,PHD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D6900 Issued in OR

Practice address

11525 SW Durham Rd
Ste. D-6
Tigard, OR 97224-3475

Phone

(503) 620-2807

Fax

(503) 968-5419

NPI assigned

Aug 4, 2011

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

Enrolled in OR

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

Credentials

Doctor of Philosophy

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.

• Bradley S. McAllister, DDS, PHD

  • Dental Clinic/Center
  • Tigard, OR
  • NPI 1295798452
  NPD (past) Authorized official
• Periodontal Associates, LLC

  • Periodontics
  • Tualatin, OR
  • NPI 1669710331
  NPD (past) Authorized official

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1922387240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 SW DURHAM RD",
            "address_2": "STE. D-6",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972243475",
            "telephone_number": "503-620-2807",
            "fax_number": "503-968-5419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11525 SW DURHAM RD",
            "address_2": "STE. D-6",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972243475",
            "telephone_number": "503-620-2807",
            "fax_number": "503-968-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCALLISTER",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DDS,PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D6900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Klein Psychology, PC
• Kathryn Virginia Mayo-Hudson, MSW, CSWA
• Kevin Maza, PHARM.D.
• Mary Wairimu Mbugua
• Theresa Ann McAdoo, O.D.
• Valerie McArthur-Burton, LCSW
• Jenna Lace McBride, OD
• Meagan McBride
• Sarah Nippelle McBride
• Alyssa McCallister, MS, CCC-SLP

• Periodontics in Tigard, OR
• Providers in Tigard, OR by specialty
• Periodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.