# J. DWIGHT BRADSHAW DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568614584
- **Authorized official:** DR. J.DWIGHT BRADSHAW DDS (OWNER)
- **Authorized official phone:** (757) 484-1444

## Contact information

- **Practice address:** 5501 BENNETTS PASTURE RD STE D, SUFFOLK, VA 23435-1500
- **Practice address phone:** (757) 484-1444
- **Practice address fax:** (757) 484-3712
- **Mailing address:** 5501 BENNETTS PASTURE RD STE D, SUFFOLK, VA 23435-1500
- **Mailing address phone:** (757) 484-1444
- **Mailing address fax:** (757) 484-3712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2008
- **Last updated:** 10/22/2008