Organization
DRS. BRADSHAW AND HATHAWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLIAM BRADSHAW (ORTHODONTIST)
(423) 929-1126
Entity
Organization
Contact information
Practice address
300 W WATAUGA AVE, JOHNSON CITY, TN 37604-5549
(423) 929-1126
Mailing address
300 W WATAUGA AVE, JOHNSON CITY, TN 37604-5549
(423) 929-1126
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2005
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16639
DORAL DENTAL/TNCARE
TN
01
—
7282
DORAL DENTAL/TNCARE
TN
Enumeration date
09/15/2006
Last updated
08/22/2020
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