Provider Demographics
NPI:1730477431
Name:BRADLEY TEW, D.D.S., P.S.
Entity Type:Organization
Organization Name:BRADLEY TEW, D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-965-9451
Mailing Address - Street 1:121 N 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2862
Mailing Address - Country:US
Mailing Address - Phone:509-965-9451
Mailing Address - Fax:
Practice Address - Street 1:121 N 50TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2862
Practice Address - Country:US
Practice Address - Phone:509-965-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60164479261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental