Provider Demographics
NPI:1295023216
Name:JONNES, BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:JONNES
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 1:19718 68TH AVE W STE F
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5965
Mailing Address - Country:US
Mailing Address - Phone:425-778-2126
Mailing Address - Fax:
Practice Address - Street 1:19718 68TH AVE W STE F
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5965
Practice Address - Country:US
Practice Address - Phone:425-778-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1014122300000X
WADE60292953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60292953OtherLICENSE #