Bradshaw, John W
Bradshaw, John W is an individual health care provider with primary practice located at 189 Corporate Dr Ste 30 , Johnson City TN 37604-2386. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Bradshaw, John W can be contacted via phone (423) 929-1126.Contact Information
Primary practice address
189 Corporate Dr Ste 30
Johnson City TN 37604-2386
Phone: (423) 929-1126
Fax: (423) 929-8111
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | 2005 | Tennessee |
Profile Details
| NPI number | 1235142282 |
|---|---|
| LBN Legal business name | Bradshaw, John W |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 14th, 2006 |
| Last updated | Dec 15th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235142282 | NPPES |
| Tennessee | MEDICAID | 3209305 |
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