Provider Demographics
NPI:1356351704
Name:BRADLEY, CARL A (DDS MAGD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DDS MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 CLINTON HWY
Mailing Address - Street 2:STE A
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849
Mailing Address - Country:US
Mailing Address - Phone:865-938-6465
Mailing Address - Fax:865-938-6454
Practice Address - Street 1:7315 CLINTON HWY
Practice Address - Street 2:STE A
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-938-6465
Practice Address - Fax:865-938-6454
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000002959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist