Healthcare Provider Details

I. General information

NPI: 1598454092
Provider Name (Legal Business Name): KAYLEE BRADFORD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 07/02/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VILLAGE RD NE STE H
LELAND NC
28451-3900
US

IV. Provider business mailing address

560G PARKERTOWN RD
FOUR OAKS NC
27524-8907
US

V. Phone/Fax

Practice location:
  • Phone: 910-371-5664
  • Fax:
Mailing address:
  • Phone: 919-802-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14267
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: