Healthcare Provider Details

I. General information

NPI: 1962541789
Provider Name (Legal Business Name): DAVID A BRADLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 EAST MAIN STREET
ADAMSVILLE TN
38310-0260
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: 731-632-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS4159
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: