Provider Demographics
NPI:1336941434
Name:BRADLEY, MADELINE ANNA (DMD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ANNA
Last Name:BRADLEY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ANNA
Other - Last Name:BURGOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4811
Mailing Address - Country:US
Mailing Address - Phone:570-214-3094
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-4811
Practice Address - Country:US
Practice Address - Phone:570-214-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program