Provider Demographics
NPI:1922895150
Name:SHENAN BRADSHAW DDS MD PA
Entity type:Organization
Organization Name:SHENAN BRADSHAW DDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE LEADER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-865-0081
Mailing Address - Street 1:660 SUMMIT CROSSING PL STE 303
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 SUMMIT CROSSING PL STE 303
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2183
Practice Address - Country:US
Practice Address - Phone:704-865-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHENAN BRADSHAW DDS MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty