Provider Demographics
NPI:1174624506
Name:BRADFORD, GEORGE M (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5741 CARMICHAEL PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2340
Mailing Address - Country:US
Mailing Address - Phone:334-277-3492
Mailing Address - Fax:334-277-9432
Practice Address - Street 1:5741 CARMICHAEL PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2340
Practice Address - Country:US
Practice Address - Phone:334-277-3492
Practice Address - Fax:334-277-9432
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000090657Medicaid
AL51090657OtherBCBS OF ALABAMA
AL51047565OtherBCBS OF ALABAMA
AL51005719OtherBCBS AL
AL511-05901OtherBC/BC OF ALABAMA
AL51549612OtherBCBS OF ALABAMA
AL650035OtherUNITED CONCORDIA
AL009910120Medicaid
AL009983310Medicaid
AL650035OtherUNITED CONCORDIA
AL000090657Medicaid