Provider Demographics
NPI:1578612701
Name:SHINAMAN, BRADFORD C (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:C
Last Name:SHINAMAN
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4130
Mailing Address - Country:US
Mailing Address - Phone:336-667-6081
Mailing Address - Fax:336-667-2172
Practice Address - Street 1:406 8TH ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4130
Practice Address - Country:US
Practice Address - Phone:336-667-6081
Practice Address - Fax:336-667-2172
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97781OtherBCBS
NC8997781Medicaid