Provider Demographics
NPI:1811156201
Name:BRADSHAW, GAYLE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 WOODLANDS PKWY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2902
Mailing Address - Country:US
Mailing Address - Phone:281-419-4655
Mailing Address - Fax:
Practice Address - Street 1:10110 WOODLANDS PKWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2902
Practice Address - Country:US
Practice Address - Phone:281-419-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics