Organization
PERIODONTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS L BRADSHAW DDS (PERIODONTIST)
(435) 652-1605
Entity
Organization
Contact information
Practice address
754 S MAIN ST STE 7, ST GEORGE, UT 84770-5517
(435) 652-1605
(435) 652-2046
Mailing address
754 S MAIN ST STE 7, ST GEORGE, UT 84770-5517
(435) 652-1605
(435) 652-2046
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
275219
UT
Other
Enumeration date
08/22/2007
Last updated
08/22/2007
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