Organization
BRADLEY A. ELI DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY ALLEN ELI DMD (PRESIDENT)
(760) 436-4062
Entity
Organization
Contact information
Practice address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 436-6365
(760) 436-5123
Mailing address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 436-6365
(760) 436-5123
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X2210X
Orofacial Pain Dentistry
Primary
—
—
125Q00000X
Oral Medicine Dentistry
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
03/08/2007
Last updated
05/11/2026
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