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General NPI Number Information
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NPI Number | 1114093739
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Entity Type | Individual
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Provider Name | ALFRED GWINN BRADFORD JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2522 W COMMERCE ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207
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Country | US
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Telephone | 210-225-4867
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Fax | 210-225-5643
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Provider Business Mailing Address
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Address Line | 3510 MARYMONT
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City | SAN ANTONIO
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State | TX
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Zip | 78217
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Country | US
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Telephone | 210-654-6752
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Fax | 210-946-0618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08923
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License Number State | TX
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