# BRADLEY A. ELI DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRADLEY A. ELI DENTAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1427740794
- **Legal business name:** BRADLEY A. ELI DENTAL CORPORATION
- **Authorized official:** DR. BRADLEY ALLEN ELI DND (CEO)
- **Authorized official phone:** (844) 235-9881

## Contact information

- **Practice address:** 5830 OBERLIN DR STE 202, SAN DIEGO, CA 92121-3754
- **Practice address phone:** (844) 235-9881
- **Practice address fax:** (760) 436-5123
- **Mailing address:** 5830 OBERLIN DR STE 202, SAN DIEGO, CA 92121-3754
- **Mailing address phone:** (844) 235-9881
- **Mailing address fax:** (760) 436-5123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X2210X | Orofacial Pain Dentistry | — | NULL | — |
| 1223X2210X | Orofacial Pain Dentistry | — | — | — |

## Other

- **Enumeration date:** 05/24/2023
- **Last updated:** 06/20/2023