Provider Demographics
NPI:1417007253
Name:BRADSHAW, DOYLE ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOYLE
Middle Name:ALAN
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:PO BOX 1100
Mailing Address - Street 2:AIRPORT RD
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1100
Mailing Address - Country:US
Mailing Address - Phone:530-625-4261
Mailing Address - Fax:530-625-5261
Practice Address - Street 1:1201 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-5261
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320301223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health