Provider Demographics
NPI:1467466755
Name:NESTER, BRADLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:NESTER
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 1387
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7387
Mailing Address - Country:US
Mailing Address - Phone:276-728-2164
Mailing Address - Fax:276-728-2165
Practice Address - Street 1:130 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-728-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice