Healthcare Provider Details

I. General information

NPI: 1306065917
Provider Name (Legal Business Name): ANDREW BRADLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NEW RIVERSIDE VILLAGE WAY UNIT 203
BLUFFTON SC
29910-3448
US

IV. Provider business mailing address

50 SPRING ISLAND DR
OKATIE SC
29909-4006
US

V. Phone/Fax

Practice location:
  • Phone: 843-949-4945
  • Fax: 843-949-4947
Mailing address:
  • Phone: 617-955-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10629
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: