Provider Demographics
NPI:1720698079
Name:BEISIEGEL, BRADLEY MILES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MILES
Last Name:BEISIEGEL
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 1:1361 BLAKE STONE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1870
Mailing Address - Country:US
Mailing Address - Phone:802-355-4849
Mailing Address - Fax:
Practice Address - Street 1:1509 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2803
Practice Address - Country:US
Practice Address - Phone:423-381-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050791223G0001X
TN11794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice