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General NPI Number Information
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NPI Number | 1306065917
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Entity Type | Individual
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Provider Name | ANDREW BRADLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 255 NEW RIVERSIDE VILLAGE WAY UNIT 203
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City | BLUFFTON
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State | SC
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Zip | 29910-3448
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Country | US
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Telephone | 843-949-4945
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Fax | 843-949-4947
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Provider Business Mailing Address
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Address Line | 50 SPRING ISLAND DR
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City | OKATIE
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State | SC
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Zip | 29909-4006
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Country | US
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Telephone | 617-955-9323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10629
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License Number State | SC
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