Provider Demographics
NPI:1124195250
Name:FARROW, BRADLEY MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MATTHEW
Last Name:FARROW
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 1:4720 TRADERS WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5366
Mailing Address - Country:US
Mailing Address - Phone:615-595-1559
Mailing Address - Fax:615-595-9945
Practice Address - Street 1:4720 TRADERS WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5366
Practice Address - Country:US
Practice Address - Phone:615-595-1559
Practice Address - Fax:615-595-9945
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100916OtherAVESIS MEDICAID
TN1516786Medicaid
GA9183408OtherDORAL MEDICAID
TN1516786OtherTENNCARE
GA605327619AMedicaid