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NPI Code Detail

MEDICARE: DR. BRADFORD JAY RHODES DMD

MEDICARE: DR. BRADFORD JAY RHODES DMD
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
11223G0001XGeneral Practice Dentistry6970OR

General Provider Information

NPI Number : 1407853567
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADFORD JAY RHODES DMD
Provider Business Mailing Address
First Line : 1110 SE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97233-1112
Country : US
Telephone Number : 503-255-7095
Fax Number : 503-255-7096
Provider Business Practice Location Address
First Line : 1110 SE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97233-1112
Country : US
Telephone Number : 503-255-7095
Fax Number : 503-255-7096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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