Provider Demographics
NPI:1043523350
Name:BRADSHAW, JOSEPH ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N 22ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7467
Mailing Address - Country:US
Mailing Address - Phone:417-590-8388
Mailing Address - Fax:
Practice Address - Street 1:5401 N 22ND ST STE C
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7467
Practice Address - Country:US
Practice Address - Phone:417-590-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD8020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist