MEDICARE: BRADNEY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DN16473	FL

General Provider Information

NPI Number	:	1275860025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADNEY CENTER

Provider Business Mailing Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 310
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3596
Country	:	US
Telephone Number	:	407-378-4000
Fax Number	:	727-820-1199

Provider Business Practice Location Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 310
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3596
Country	:	US
Telephone Number	:	407-378-4000
Fax Number	:	727-820-1199

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SEAN WALCOTT
Credential	:	D.D.S
Telephone Number	:	407-378-4000

Provider Enumeration Date	:	11/13/2009
Last Update Date	:	11/13/2009

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Directions to “BRADNEY CENTER ” Practice Location

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