MEDICARE: DR. BRADLEY ALAN TAYLOR 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11715	FL

General Provider Information

NPI Number	:	1639376239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY ALAN TAYLOR D.M.D.

Provider Business Mailing Address
First Line	:	2517 BURNS RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5204
Country	:	US
Telephone Number	:	561-775-7999
Fax Number	:	561-775-5777

Provider Business Practice Location Address
First Line	:	2517 BURNS RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5204
Country	:	US
Telephone Number	:	561-775-7999
Fax Number	:	561-775-5777

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/08/2007

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