MEDICARE: DR. BRADLEY JAY PIERSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5346802-9921	UT
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27494	TX

General Provider Information

NPI Number	:	1053532606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY JAY PIERSON DDS

Provider Business Mailing Address
First Line	:	8358 N LOOP 1604 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3980
Country	:	US
Telephone Number	:	210-695-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	8358 N LOOP 1604 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3980
Country	:	US
Telephone Number	:	210-695-1116
Fax Number	:	210-695-1108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	06/25/2019

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