Active NPI
Damon G Bradford Jr., DDS
- Periodontics
- Monroe, LA
National Provider Identifier
1972626737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2792
- Practice address
- 2005 Forsythe Ave
Monroe, LA 71201 - Phone
- (318) 388-2630
- Fax
- (318) 322-4537
- NPI assigned
- Apr 9, 2007
- Last updated
- Mar 31, 2016
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2792 | LA | Primary |
Addresses
Primary practice location
2005 Forsythe Ave
Monroe, LA 71201
Mailing address
2005 Forsythe Ave
Monroe, LA 71201
Phone (318) 388-2630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160511001069 | LA | Order and Referring Only - Oral Surgery | 1052600251 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2792 | LA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459382400000",
"number": "1972626737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 FORSYTHE AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "71201",
"telephone_number": "318-388-2630",
"fax_number": "318-322-4537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 FORSYTHE AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "71201",
"telephone_number": "318-388-2630",
"fax_number": "318-322-4537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADFORD",
"first_name": "DAMON",
"middle_name": "G",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2016-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "LA",
"license": "2792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.