Individual
DR. SHENAN MARIE BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MD
Contact information
Practice address
17300 N OUTER 40 RD STE 103, CHESTERFIELD, MO 63005-1364
(636) 536-5158
Mailing address
17300 N OUTER 40 RD STE 103, CHESTERFIELD, MO 63005-1364
(636) 536-5158
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2020029150
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020029150
DENTAL LICENSE
MO
01
—
2021010068
MEDICAL LICENSE
MO
Enumeration date
03/16/2012
Last updated
01/18/2025
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