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General NPI Number Information
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NPI Number | 1922166354
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Entity Type | Individual
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Provider Name | BRADLEY SCOTT MATTHEW D.D.S
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD #808
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City | LOS ANGELES
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State | CA
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Zip | 90045-3807
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Country | US
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Telephone | 310-670-0659
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Fax | 310-670-6880
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Provider Business Mailing Address
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Address Line | 2050 S BENTLEY AVE #303
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City | LOS ANGELES
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State | CA
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Zip | 90025-5661
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Country | US
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Telephone | 310-914-4904
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48510
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License Number State | CA
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