Bradley Bishop Diminick, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11078 Issued in TN

Practice address

2975 Fort Henry Dr Ste a
Kingsport, TN 37664-4005

Phone

(423) 247-9196

NPI assigned

Jun 10, 2019

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1417516733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5642 JOHN GAINES BLVD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376646532",
            "telephone_number": "423-863-6114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 FORT HENRY DR STE A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376644005",
            "telephone_number": "423-247-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMINICK",
        "first_name": "BRADLEY",
        "middle_name": "BISHOP",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernest Dickson, PT
• Heather Jeanette Dickson, PMHNP
• Paul Diers, PA-C
• Daniel Martin Dietrich, D.D.S.
• Kelli Lynn Dillon, BSW
• Marin Dimitrov, MD
• Marcie Dingus, PHARMD
• Brittany Dixon
• Mark C Dixon, MD
• DLS Ventures, LLC.

• General Practice Dentistry in Kingsport, TN
• Providers in Kingsport, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.