MEDICARE: DR. ANDREW BRADLEY DMD

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	1223E0200X	Endodontics	10629	SC

General Provider Information

NPI Number	:	1306065917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW BRADLEY DMD

Provider Business Mailing Address
First Line	:	50 SPRING ISLAND DR
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-4006
Country	:	US
Telephone Number	:	617-955-9323
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 NEW RIVERSIDE VILLAGE WAY UNIT 203
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-3448
Country	:	US
Telephone Number	:	843-949-4945
Fax Number	:	843-949-4947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/13/2025

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