Healthcare Provider Details

I. General information

NPI: 1467466755
Provider Name (Legal Business Name): BRADLEY S NESTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH MAIN STREET
HILLSVILLE VA
24343
US

IV. Provider business mailing address

PO BOX 1387
HILLSVILLE VA
24343-7387
US

V. Phone/Fax

Practice location:
  • Phone: 276-728-2164
  • Fax:
Mailing address:
  • Phone: 276-728-2164
  • Fax: 276-728-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008084
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: