Provider Demographics
NPI:1598454092
Name:BRADFORD, KAYLEE (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYLEE
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560G PARKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-8907
Mailing Address - Country:US
Mailing Address - Phone:919-802-1140
Mailing Address - Fax:
Practice Address - Street 1:117 VILLAGE RD NE STE H
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-3900
Practice Address - Country:US
Practice Address - Phone:910-371-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist