Provider Demographics
NPI:1346404878
Name:KIRST, BRADLEY J (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:KIRST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23838 VALENCIA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5333
Mailing Address - Country:US
Mailing Address - Phone:661-288-2088
Mailing Address - Fax:
Practice Address - Street 1:23838 VALENCIA BLVD STE 180
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5333
Practice Address - Country:US
Practice Address - Phone:661-288-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY0336041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice