Provider Demographics
NPI:1790099133
Name:TEW, BRADLEY DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DARRELL
Last Name:TEW
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 1:121 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:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60164479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist