BRADLEY RANDALL CONGLETON (NPI# 1952754749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952754749 |
| Entity Type | Individual |
| Full Name | BRADLEY RANDALL CONGLETON |
| Credential | DMD |
| Practice Address |
2215 Portland Ave Louisville KY 40212-1033 |
| Mailing Address |
Po Box 950244 Louisville KY 40295-0244 |
| Practice Telephone | 5027748631 |
| Practice Fax Number | 5029968309 |
| Mailing Telephone | 5027728160 |
| Mailing Fax Number | 5027728108 |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2019-12-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
9824 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100435410 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16005 Us Route 23, Catlettsburg, KY 411299070 | 6067390403 |
| Street Address |
2215 PORTLAND AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40212-1033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003810920 | Julia E Richerson | Pediatrics | 2215 Portland Ave, Louisville, KY 40212-1033 | 2005-06-09 |
| 1609431097 | Pamela Lynn Ratcliffe | Social Worker | 2215 Portland Ave, Louisville, KY 40212-1033 | 2019-05-01 |
| 1518453075 | Dana Renee Singletary | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212-1033 | 2018-07-09 |
| 1881105823 | Emily B Franck | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212-1033 | 2017-10-17 |
| 1164874160 | Patricia Guzman Rojas | Family Medicine | 2215 Portland Ave, Louisville, KY 40212-1033 | 2016-07-01 |
| 1750738936 | Paula W. Minervino | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212-1033 | 2016-05-18 |
| 1043670391 | Rod Ali Erfani | Dentist | 2215 Portland Ave, Louisville, KY 40212 | 2016-02-29 |
| 1013389022 | Izegbea M. Cannon | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212-1033 | 2015-10-29 |
| 1659742914 | Tonia Marie Snyder-myers | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212-1033 | 2015-10-13 |
| 1417338989 | Shannon Smith Wheeler | Dentist | 2215 Portland Ave, Louisville, KY 40212-1033 | 2015-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003433111 | Shanita Flanagan | Home Health Aide | 4519 Southwestern Parkway, Louisville, KY 40212 | 2020-07-06 |
| 1184118887 | Denise Goldsmith-kelley | Licensed Practical Nurse | 2611 Northwestern Pkwy, Louisville, KY 40212 | 2018-06-18 |
| 1477605426 | Market St Dental Office Psc | Dentist | 2410 West Market St, Louisville, KY 40212 | 2007-01-18 |
| 1528118601 | Portland Dental Psc | Clinic/Center | 465 North 26th Street, Louisville, KY 40212 | 2007-01-11 |
| 1790393643 | Quality Home Care Services, LLC | In Home Supportive Care | 4519 Southwestern Parkway, Same, Louisville, KY 40212 | 2020-07-16 |
| 1659884872 | New Leaf Clinic | Clinic/Center | 2910 W Jefferson St, Louisville, KY 40212 | 2017-11-09 |
| 1164754008 | Deborah J Moreau | Nurse Practitioner | 234 Amy Ave, Louisville, KY 40212 | 2010-02-03 |
| 1982617387 | Julie R Aull | Physician Assistant | 234 Amy Ave, Louisville, KY 40212 | 2006-08-15 |
| 1255816401 | Restoration Center Inc. | Respite Care | 2611 Northwestern Pkwy, Louisville, KY 40212-1029 | 2018-10-03 |
| 1386038040 | Lufield Dialysis LLC | Clinic/Center | 2118 Portland Ave, Louisville, KY 40212-1032 | 2015-03-20 |
| Find all providers in zip 40212 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235781485 | Rylie Mike-mayer | Dentist | 302 Axis Dr Apt 401, Louisville, KY 40206-0139 | 2019-07-09 |
| 1922580653 | Advanced Dental Center, Inc. | Dentist | 1901 Rudy Ln Ste 4, Louisville, KY 40207-1384 | 2018-08-29 |
| 1043701451 | Diana H Tran | Dentist | 501 S Preston St Rm 148, Louisville, KY 40202-1701 | 2018-05-21 |
| 1992295653 | Tyler Benton Blount | Dentist | 8013 New La Grange Rd Ste 6, Louisville, KY 40222-4700 | 2018-05-17 |
| 1407346901 | Louisville Dental Associates LLC | Dentist | 16701 E Main St, Louisville, MS 39339-2751 | 2018-05-10 |
| 1194238816 | Dental Services of Kentucky, Psc | Dentist | 2011 Grinstead Dr Unit 102, Louisville, KY 40204-1296 | 2017-11-16 |
| 1366963373 | Caleb William Reece | Dentist | 2201 Biljana Dr Apt 1, Louisville, KY 40206-2175 | 2017-06-29 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1740733559 | Jonathan Mitchell, Dmd, Psc | Dentist | 1716 Gardiner Ln, Louisville, KY 40205-2738 | 2016-07-27 |
| 1215389168 | Charles Kendrick Bunch | Dentist | 1030 Mulberry St, Louisville, KY 40217-1253 | 2016-07-04 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40212 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.