Healthcare Provider Details

I. General information

NPI: 1134824055
Provider Name (Legal Business Name): BRADLEY FAMILY DENTISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E MAIN ST
ADAMSVILLE TN
38310-2321
US

IV. Provider business mailing address

PO BOX 260
ADAMSVILLE TN
38310-0260
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-1680
  • Fax: 731-632-1680
Mailing address:
  • Phone: 731-632-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAXWELL BRADLEY
Title or Position: DENTIST
Credential: DDS
Phone: 731-646-0180