Bradford C Shinaman, D.D.S.,PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5183 Issued in NC

Practice address

406 8TH St
North Wilkesboro, NC 28659-4130

Phone

(336) 667-6081

Fax

(336) 667-2172

NPI assigned

Jan 9, 2007

Last updated

Mar 21, 2013By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bradford C Shinaman DDS PA

  • Dental Clinic/Center
  • North Wilkesboro, NC
  • NPI 1790952489
  NPD (past) Authorized official
• A. Todd Smith, DDS PA

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Winston Salem, NC
  • NPI 1275500167
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1578612701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 8TH ST",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286594130",
            "telephone_number": "336-667-6081",
            "fax_number": "336-667-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 8TH ST",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286594130",
            "telephone_number": "336-667-6081",
            "fax_number": "336-667-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINAMAN",
        "first_name": "BRADFORD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97781",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8997781",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey Elledge Sheets, FNP-C
• Ashley Anna Shell
• Robyn Shelton, MS, OTR/L
• Donna Grasmehr Shew
• Willard Jeffrey Shew, CRNA
• Erica Mathis Shore, FNP
• Mandy Suzanne Eller Shumate, FNP
• Morgan Taylor Shumate
• Heather Wolfe Sidden, RN
• Myron Skoski, PA

• General Practice Dentistry in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.