Provider Demographics
NPI:1023147790
Name:WILKINSON, BRADLEY W (DDS MS PC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:WILKINSON
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Gender:M
Credentials:DDS MS PC
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Mailing Address - Street 1:5040 SANDERLIN AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-761-5155
Mailing Address - Fax:901-761-5130
Practice Address - Street 1:5040 SANDERLIN AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-761-5155
Practice Address - Fax:901-761-5130
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDS0051401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry