Provider Demographics
NPI:1356508147
Name:BRADSHAW, JONATHAN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:BRADSHAW
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 1:11121 KINGSTON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2890
Mailing Address - Country:US
Mailing Address - Phone:865-986-5310
Mailing Address - Fax:865-986-5319
Practice Address - Street 1:11121 KINGSTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2890
Practice Address - Country:US
Practice Address - Phone:865-986-5310
Practice Address - Fax:865-986-5319
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice