MEDICARE: DR. BRADLEY JOSEPH MACDONALD 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	1223G0001X	General Practice Dentistry	10710	NC

General Provider Information

NPI Number	:	1851820914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY JOSEPH MACDONALD DMD

Provider Business Mailing Address
First Line	:	9924 US HIGHWAY 311
Second Line	:
City	:	ARCHDALE
State	:	NC
Zip	:	27263-8826
Country	:	US
Telephone Number	:	336-434-3186
Fax Number	:	336-434-3189

Provider Business Practice Location Address
First Line	:	9924 US HIGHWAY 311
Second Line	:
City	:	ARCHDALE
State	:	NC
Zip	:	27263-8826
Country	:	US
Telephone Number	:	336-434-3186
Fax Number	:	336-434-3189

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	06/12/2017

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