Provider Demographics
NPI:1164486502
Name:BRADLEY, BRENDA SHAY (DDS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SHAY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7032 FOREST HILL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1608
Mailing Address - Country:US
Mailing Address - Phone:804-272-2840
Mailing Address - Fax:804-272-1844
Practice Address - Street 1:7032 FOREST HILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1608
Practice Address - Country:US
Practice Address - Phone:804-272-2840
Practice Address - Fax:804-272-1844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice