Provider Demographics
NPI:1578741773
Name:WINN, BRADLEY LOGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LOGAN
Last Name:WINN
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 1:148 STUART CROSSING NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-0000
Mailing Address - Country:US
Mailing Address - Phone:423-472-6482
Mailing Address - Fax:423-472-6699
Practice Address - Street 1:148 STUART XING NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4065
Practice Address - Country:US
Practice Address - Phone:423-472-6482
Practice Address - Fax:423-472-6699
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice