Provider Demographics
NPI:1871090787
Name:GILL, BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 HILLSBORO PIKE STE 106
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3339
Mailing Address - Country:US
Mailing Address - Phone:615-730-5566
Mailing Address - Fax:
Practice Address - Street 1:625 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:934-205-1021
Practice Address - Fax:205-975-6519
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN109881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice