Provider Demographics
NPI:1508991951
Name:BRADSHAW, DENNIS LYLE (D D S)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LYLE
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 W GRANDRIDGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6708
Mailing Address - Country:US
Mailing Address - Phone:509-547-9549
Mailing Address - Fax:509-547-6604
Practice Address - Street 1:4403 W COURT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2879
Practice Address - Country:US
Practice Address - Phone:509-547-9549
Practice Address - Fax:509-547-6604
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6183122300000X
WADE000061831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist