MEDICARE: DR. BRADLEY M WOODHAM D.M.D.

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	1223G0001X	General Practice Dentistry	DN 17101	FL

General Provider Information

NPI Number	:	1437139623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY M WOODHAM D.M.D.

Provider Business Mailing Address
First Line	:	6120 WINKLER RD STE I
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8192
Country	:	US
Telephone Number	:	239-481-6433
Fax Number	:	239-481-6455

Provider Business Practice Location Address
First Line	:	6120 WINKLER RD STE I
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8192
Country	:	US
Telephone Number	:	239-481-6433
Fax Number	:	239-481-6455

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/21/2022

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