Provider Demographics
NPI:1548584337
Name:DENNIS L BRADSHAW
Entity Type:Organization
Organization Name:DENNIS L BRADSHAW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-547-9549
Mailing Address - Street 1:4403 W COURT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2879
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty