Individual
DR. BRADLEY BISHOP DIMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2975 FORT HENRY DR STE A, KINGSPORT, TN 37664-4005
(423) 247-9196
Mailing address
5642 JOHN GAINES BLVD, KINGSPORT, TN 37664-6532
(423) 863-6114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11078
TN
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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