Thomas Lee Bradshaw, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

275219 Issued in UT

Practice address

754 S Main St Ste 7
Saint George, UT 84770-5517

Phone

(435) 652-1605

Fax

(435) 652-2046

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 4, 2016 through Apr 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Periodontal Specialists

  • Periodontics
  • St George, UT
  • NPI 1750574810
  NPD (past) Authorized official
• Christopher Rollins, DMD, PLLC

  • Periodontics
  • St George, UT
  • NPI 1568382695
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235151564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST STE 7",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847705517",
            "telephone_number": "435-652-1605",
            "fax_number": "435-652-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST STE 7",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847705517",
            "telephone_number": "435-652-1605",
            "fax_number": "435-652-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "THOMAS",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "UT",
            "license": "275219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Michael Bradshaw, S.S.W.
• Elizabeth Bradshaw
• Jared Boston Bradshaw
• Kenzie Bradshaw
• Melonie Bradshaw, PEER SUPPORT
• Kiley Brady
• Brenda E Brailsford
• Brain Body Balance Treatment Centers
• Brain Health Center LLC
• Bronwyn Brand

• Periodontics in Saint George, UT
• Providers in Saint George, UT by specialty
• Periodontics in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.