Healthcare Provider Details

I. General information

NPI: 1922857770
Provider Name (Legal Business Name): BRADLEY DEVINE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 CALLE REAL
GOLETA CA
93117-2317
US

IV. Provider business mailing address

4003 PRIMAVERA RD
SANTA BARBARA CA
93110-1467
US

V. Phone/Fax

Practice location:
  • Phone: 805-456-3063
  • Fax:
Mailing address:
  • Phone: 805-448-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: