Provider Demographics
NPI:1902450950
Name:GAW, BRAD THOMAS
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:THOMAS
Last Name:GAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 N GRUNDY QUARLES HWY
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-9691
Mailing Address - Country:US
Mailing Address - Phone:931-268-2869
Mailing Address - Fax:931-268-9837
Practice Address - Street 1:187 N GRUNDY QUARLES HWY
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-9691
Practice Address - Country:US
Practice Address - Phone:931-268-2869
Practice Address - Fax:931-268-9837
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN109051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice