Porter, Bradley Thain

Porter, Bradley Thain is an individual health care provider with primary practice located at 6755 E Superstition Springs Blvd Suite 103, Mesa AZ 85206-4373. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Porter, Bradley Thain can be contacted via phone (480) 830-5866.

Contact Information

Primary practice address
6755 E Superstition Springs Blvd Suite 103 Mesa AZ 85206-4373
Phone: (480) 830-5866
Fax: (480) 807-0606
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 4124 Arizona

Profile Details

NPI number 1023095734
LBN Legal business name Porter, Bradley Thain
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 23rd, 2005
Last updated Dec 4th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023095734 NPPES
Arizona MEDICAID 2173766
Arizona Other AZ0482170

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