Healthcare Provider Details

I. General information

NPI: 1962862003
Provider Name (Legal Business Name): ASHLEY DANIELLE BRADLEY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W BAY DR
LARGO FL
33770-3221
US

IV. Provider business mailing address

875 W BAY DR
LARGO FL
33770-3221
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-4443
  • Fax:
Mailing address:
  • Phone: 727-777-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: