Provider Demographics
NPI:1700994852
Name:TOWNSEND, BRADLEY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LYNN
Last Name:TOWNSEND
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 1:6019 N. EAGLE RD.
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-377-2777
Mailing Address - Fax:208-377-3075
Practice Address - Street 1:6019 N. EAGLE RD.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-377-2777
Practice Address - Fax:208-377-3075
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59101223P0300X
IA065801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48924Medicare UPIN
191809Medicare ID - Type Unspecified