Provider Demographics
NPI:1114710472
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:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-1000
Mailing Address - Street 1:2105 BRAXTON LN STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 BRAXTON LN STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2863
Practice Address - Country:US
Practice Address - Phone:336-273-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHENAN BRADSHAW DDS MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty