Healthcare Provider Details

I. General information

NPI: 1588680268
Provider Name (Legal Business Name): BRADLEY TAYLER HAMMOND DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16936 W BELL RD STE 203
SURPRISE AZ
85374-8949
US

IV. Provider business mailing address

15566 N 177TH DR
SURPRISE AZ
85388-3101
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-1875
  • Fax:
Mailing address:
  • Phone: 623-328-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: