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General NPI Number Information
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NPI Number | 1740510775
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Entity Type | Organization
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Legal Business Name | BRADLEY W. WILKINSON
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 5040 SANDERLIN AVE STE 101
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City | MEMPHIS
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State | TN
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Zip | 38117-4374
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Country | US
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Telephone | 901-761-5155
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Fax | 901-761-5130
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Provider Business Mailing Address
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Address Line | 5040 SANDERLIN AVE STE 101
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City | MEMPHIS
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State | TN
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Zip | 38117-4374
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Country | US
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Telephone | 901-761-5155
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Fax | 901-761-5130
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Authorized Official
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Title or Position | DENTIST
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Name | BRADLEY W WILKINSON
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Credential | DDS
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Telephone | 901-761-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS005140
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License Number State | TN
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