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General NPI Number Information
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NPI Number | 1952081051
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Entity Type | Individual
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Provider Name | BRADLEY MYCHEL PELHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 3795 N STOCKTON HILL RD
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City | KINGMAN
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State | AZ
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Zip | 86409-3057
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Country | US
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Telephone | 928-352-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 3149 PALO VERDE BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-1470
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Country | US
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Telephone | 626-623-9449
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 109057
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011911
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DB-2023-0196
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License Number State | NM
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