Provider Demographics
NPI:1730227182
Name:BRADSHAW, CLIFFORD JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:JOHN
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S HAM LANE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242
Mailing Address - Country:US
Mailing Address - Phone:209-368-4141
Mailing Address - Fax:209-368-7450
Practice Address - Street 1:801 S HAM LANE
Practice Address - Street 2:SUITE D
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242
Practice Address - Country:US
Practice Address - Phone:209-368-4141
Practice Address - Fax:209-368-7450
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist