Provider Demographics
NPI:1275845703
Name:BRADSHAW, ERIC MICHAEL SR (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:BRADSHAW
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 RHODE ISLAND AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-8129
Mailing Address - Country:US
Mailing Address - Phone:202-529-6468
Mailing Address - Fax:202-529-3052
Practice Address - Street 1:329 RHODE ISLAND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8129
Practice Address - Country:US
Practice Address - Phone:202-529-6468
Practice Address - Fax:202-529-3052
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000884122300000X
MD17975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist