Provider Demographics
NPI:1952315301
Name:SHENAN BRADSHAW DDS MD PA
Entity type:Organization
Organization Name:SHENAN BRADSHAW DDS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-621-1554
Mailing Address - Street 1:2708 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-621-1554
Mailing Address - Fax:336-621-3402
Practice Address - Street 1:2708 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-621-1554
Practice Address - Fax:336-621-3402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHENAN BRADSHAW DDS MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02635OtherBCBS
NC89016AEMedicaid
NC2345053Medicare ID - Type Unspecified