Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 32030 | CA |
NPI | 1417007253 |
---|---|
Provider Name | Dr. Doyle Alan Bradshaw |
First Address | Hoopa, CA 95546-1100 |
Second Address | Hoopa, CA 95546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |