Healthcare Provider Details

I. General information

NPI: 1023933421
Provider Name (Legal Business Name): BRADFORD DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 300 S
PAYSON UT
84651-2801
US

IV. Provider business mailing address

509 E 570 S
NEPHI UT
84648-2166
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-3233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAKOB BRADFORD
Title or Position: OWNER - DENTIST
Credential: DDS
Phone: 435-660-6392