NPIMap

Organization Active NPI

Shenan Bradshaw DDS MD PA

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Greensboro, NC
National Provider Identifier
1114710472
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
SHENAN BRADSHAW DDS MD PA
Practice address
2105 Braxton LN Ste 102
Greensboro, NC 27408-2863
Phone
(336) 273-1000
NPI assigned
May 28, 2025
Organization subpart
Yes
Parent organization
SHENAN BRADSHAW DDS MD PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Allison Jarrell
Title
Practice Leader
Phone
(336) 273-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

2105 Braxton LN Ste 102
Greensboro, NC 27408-2863

Mailing address

2105 Braxton LN Ste 102
Greensboro, NC 27408-2863

Other practice location 1

3493 Forestdale Dr Ste 102
Burlington, NC 27215-8246
Phone (336) 417-5933

Other names 1

  • Piedmont Oral and Maxillofacial Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250925000948 NC Part B Supplier - Clinic/Group Practice 3779007711 Receives reassigned benefits from 2 practitioners
Practice locations: Burlington, NC; Greensboro, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Piedmont Oral Maxillofacia4 organizations share this tax ID, including this one
Part of
Piedmont Oral Maxillofacia

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3493 Forestdale Dr
Ste 102
Burlington, NC 27215
Phone (336) 417-5933

2105 Braxton Ln
Ste 102
Greensboro, NC 27408
Phone (336) 273-1000

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1114710472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BRAXTON LN STE 102",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274082863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BRAXTON LN STE 102",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274082863",
            "telephone_number": "336-273-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3493 Forestdale Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272158246",
            "country_code": "US",
            "telephone_number": "336-417-5933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHENAN BRADSHAW DDS MD PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHENAN BRADSHAW DDS MD PA",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "JARRELL",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "PRACTICE LEADER",
        "authorized_official_telephone_number": "336-273-1000"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Oral and Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.