Provider Demographics
NPI:1023279403
Name:WHITE, BRADLEY WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:WILLIAM
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1912 PINNACLE POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-573-4593
Mailing Address - Fax:865-444-2938
Practice Address - Street 1:1912 PINNACLE POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-573-4593
Practice Address - Fax:865-444-2938
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice