MEDICARE: COLBY TRENTON BRADFORD D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	26182	FL
2	122300000X	Dentist	26182	FL

General Provider Information

NPI Number	:	1831769058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLBY TRENTON BRADFORD D.M.D.

Provider Business Mailing Address
First Line	:	12812 SOUTH SHORE DRIVE
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410
Country	:	US
Telephone Number	:	561-339-9948
Fax Number	:

Provider Business Practice Location Address
First Line	:	11380 PROSPERITY FARMS RD STE 117
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3464
Country	:	US
Telephone Number	:	561-694-3006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	10/23/2024

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