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General NPI Number Information
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NPI Number | 1205948270
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Entity Type | Individual
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Provider Name | BRADLEY A ELI DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 4403 MANCHESTER AVE SUITE 101
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City | ENCINITAS
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State | CA
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Zip | 92024-4939
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Country | US
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Telephone | 760-436-6365
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Fax | 760-436-5123
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Provider Business Mailing Address
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Address Line | 4403 MANCHESTER AVE SUITE 101
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City | ENCINITAS
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State | CA
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Zip | 92024-4939
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Country | US
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Telephone | 760-436-6365
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Fax | 760-436-5123
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS36308
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | DS36308
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 36308
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 36308
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | DS36308
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License Number State | CA
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