NPIMap

Organization Active NPI

Family Dentistry by Design

  • General Practice Dentistry
  • Kingman, AZ
National Provider Identifier
1982076097
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7614 Issued in AZ
Legal business name
FAMILY DENTISTRY BY DESIGN
Practice address
1848 Hope Ave
Suite 2
Kingman, AZ 86401-4190
Phone
(928) 753-5200
Fax
(928) 753-5205
NPI assigned
Oct 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Authorized official

Name
Dr. Kelly Bradley, DMDNPI 1447415799
Title
Owner / Dentist
Phone
(928) 897-9946

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7614 AZ Primary

Addresses

Primary practice location

1848 Hope Ave
Suite 2
Kingman, AZ 86401-4190

Mailing address

1848 Hope Ave
Suite 2
Kingman, AZ 86401-4190
Phone (928) 753-5200

National Provider Directory

National Provider Directory

Locations

1848 Hope Ave
Ste 2
Kingman, AZ 86401
Phone (928) 753-5200

Practitioners & affiliated clinicians

Practitioners 2

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": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1982076097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 HOPE AVE",
            "address_2": "SUITE 2",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014190",
            "telephone_number": "928-753-5200",
            "fax_number": "928-753-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 HOPE AVE",
            "address_2": "SUITE 2",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014190",
            "telephone_number": "928-753-5200",
            "fax_number": "928-753-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY BY DESIGN",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER / DENTIST",
        "authorized_official_telephone_number": "928-897-9946",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "7614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.