Healthcare Provider Details

I. General information

NPI: 1871802223
Provider Name (Legal Business Name): BRAD PODRAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SCHOOL LN SUITE 101
HARLEYSVILLE PA
19438-1715
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 215-513-1551
  • Fax: 215-513-4255
Mailing address:
  • Phone: 267-460-4254
  • Fax: 215-646-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038092
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: