Individual
DR. DANIEL W BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
300 W WATAUGA AVE, JOHNSON CITY, TN 37604-5549
(423) 929-8111
(423) 929-8111
Mailing address
300 W WATAUGA AVE, JOHNSON CITY, TN 37604-5549
(423) 929-8111
(423) 929-8111
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7691
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16639
TENNCARE/DORAL DENAL
TN
Enumeration date
08/14/2006
Last updated
07/08/2007
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