Provider Demographics
NPI:1154645471
Name:FIELD, BRADLEY BLAKE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:BLAKE
Last Name:FIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2190 NE PROFESSIONAL CT STE 200
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6985
Mailing Address - Country:US
Mailing Address - Phone:541-907-1611
Mailing Address - Fax:541-617-0336
Practice Address - Street 1:2190 NE PROFESSIONAL CT STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6985
Practice Address - Country:US
Practice Address - Phone:541-907-1611
Practice Address - Fax:541-617-0336
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA612511223P0221X, 1223P0221X
ORD99581223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry