NPIMap

Organization Active NPI

Bradley a. Eli Dental Corporation

  • Orofacial Pain Dentistry
  • Vista, CA
National Provider Identifier
1962533919
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orofacial Pain DentistryTaxonomy code 1223X2210X
Legal business name
BRADLEY A. ELI DENTAL CORPORATION
Practice address
2095 W Vista Way Ste 218
Vista, CA 92083-6029
Phone
(760) 436-6365
Fax
(760) 436-5123
NPI assigned
Mar 8, 2007
Last updated
May 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Authorized official

Name
Dr. Bradley Allen Eli, DMDNPI 1205948270
Title
President
Phone
(760) 436-4062

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orofacial Pain DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X2210X Primary
Oral Medicine DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 125Q00000X

Addresses

Primary practice location

2095 W Vista Way Ste 218
Vista, CA 92083-6029

Mailing address

2095 W Vista Way Ste 218
Vista, CA 92083-6029
Phone (760) 436-6365

Other practice location 1

5830 Oberlin Dr Ste 202
San Diego, CA 92121-3754
Phone (760) 436-6365

Other practice location 2

11980 San Vicente Blvd Ste 814
Los Angeles, CA 90049-6606
Phone (760) 436-6365

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150611001901 CA Part B Supplier - Clinic/Group Practice 1557682804 Receives reassigned benefits from 6 practitioners
Practice locations: Los Angeles, CA; San Diego, CA; Vista, CA

National Provider Directory

National Provider Directory

Locations

4403 Manchester Ave
Ste 101
Encinitas, CA 92024
Phone (760) 436-6365

11980 San Vicente Blvd
Ste 811
Los Angeles, CA 90049
Phone (310) 826-8911

5830 Oberlin Dr
Ste 202
San Diego, CA 92121
Phone (760) 436-6365

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1962533919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 W VISTA WAY STE 218",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836029",
            "telephone_number": "760-436-6365",
            "fax_number": "760-436-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 W VISTA WAY STE 218",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836029",
            "telephone_number": "760-436-6365",
            "fax_number": "760-436-5123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5830 Oberlin Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921213754",
            "country_code": "US",
            "telephone_number": "760-436-6365",
            "fax_number": "760-436-5123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11980 San Vicente Blvd Ste 814",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900496606",
            "country_code": "US",
            "telephone_number": "760-436-6365",
            "fax_number": "760-436-5123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRADLEY A. ELI DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "ELI",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-436-4062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orofacial Pain",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "125Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.