| Periodontal Specialists | |
|
754 S Main St Ste 7 St George UT 84770-5517 | |
| (435) 652-1605 | |
| (435) 652-2046 |
| Full Name | Periodontal Specialists |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 754 S Main St Ste 7, St George, Utah |
| Authorized Official Name and Position | Thomas L Bradshaw (PERIODONTIST) |
| Authorized Official Contact | 4356521605 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontal Specialists 754 S Main St Ste 7 St George UT 84770-5517 Ph: (435) 652-1605 | Periodontal Specialists 754 S Main St Ste 7 St George UT 84770-5517 Ph: (435) 652-1605 |
| NPI Number | 1750574810 |
|---|---|
| Provider Enumeration Date | 08/22/2007 |
| Last Update Date | 08/22/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750574810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 275219 (Utah) | Primary |
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