Provider Demographics
NPI:1164431730
Name:THWEATT, BRADFORD R (DDS)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:R
Last Name:THWEATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 WHITESIDE RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2345
Mailing Address - Country:US
Mailing Address - Phone:804-737-4444
Mailing Address - Fax:
Practice Address - Street 1:5500 WHITESIDE RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2345
Practice Address - Country:US
Practice Address - Phone:804-737-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist