Healthcare Provider Details

I. General information

NPI: 1417007253
Provider Name (Legal Business Name): DOYLE ALAN BRADSHAW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 AIRPORT RD
HOOPA CA
95546
US

IV. Provider business mailing address

PO BOX 1100 AIRPORT RD
HOOPA CA
95546-1100
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax: 530-625-5261
Mailing address:
  • Phone: 530-625-4261
  • Fax: 530-625-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number32030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: