Provider Demographics
NPI:1346268208
Name:BARLOW, BRADLEY SHANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SHANE
Last Name:BARLOW
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 1:602 N CALGARY CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4000
Mailing Address - Country:US
Mailing Address - Phone:208-777-9331
Mailing Address - Fax:208-777-9335
Practice Address - Street 1:602 N CALGARY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4000
Practice Address - Country:US
Practice Address - Phone:208-777-9331
Practice Address - Fax:208-777-9335
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-37811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806893400Medicaid