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General NPI Number Information
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NPI Number | 1790608842
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Entity Type | Individual
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Provider Name | COLLIN BRADLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 25501 BRAINARD AVE
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City | FORT GORDON
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State | GA
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Zip | 30905-5660
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Country | US
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Telephone | 706-787-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 2034 SUMMERTON CIR
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City | EVANS
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State | GA
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Zip | 30809-6702
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Country | US
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Telephone | 314-482-5093
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN31695
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License Number State | FL
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