Provider Demographics
NPI:1326630187
Name:DAVID BRADLEY DDS INC.
Entity Type:Organization
Organization Name:DAVID BRADLEY DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-632-1680
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0260
Mailing Address - Country:US
Mailing Address - Phone:731-632-1680
Mailing Address - Fax:731-632-1680
Practice Address - Street 1:349 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2321
Practice Address - Country:US
Practice Address - Phone:731-632-1680
Practice Address - Fax:731-632-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty