Provider Demographics
NPI:1962529263
Name:HART, JOSEPH BRADFORD (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRADFORD
Last Name:HART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8311
Mailing Address - Country:US
Mailing Address - Phone:617-680-0884
Mailing Address - Fax:617-307-4595
Practice Address - Street 1:311 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8311
Practice Address - Country:US
Practice Address - Phone:617-680-0884
Practice Address - Fax:617-307-4595
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18975122300000X, 1223G0001X
NY047597-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05886897Medicaid