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General NPI Number Information
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NPI Number | 1841505757
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Entity Type | Individual
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Provider Name | LINH TRUONG BRADBERRY DMD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 10915 BAYMEADOWS RD STE 106
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9131
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Country | US
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Telephone | 904-619-6478
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Fax | 904-580-4262
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Provider Business Mailing Address
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Address Line | 5911 TIMUQUANA RD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8174
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Country | US
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Telephone | 904-993-6088
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Fax | 904-993-6088
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19050
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License Number State | FL
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