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General NPI Number Information
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NPI Number | 1265906127
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Entity Type | Organization
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Legal Business Name | BRAD PODRAY ORTHODONTICS LLC
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 201 S ANKENY BLVD
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City | ANKENY
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State | IA
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Zip | 50023-3116
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Country | US
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Telephone | 515-964-5602
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S ANKENY BLVD
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City | ANKENY
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State | IA
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Zip | 50023-3116
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Country | US
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Telephone | 515-964-5602
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAD ANDREW PODRAY
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Credential | DMD
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Telephone | 561-699-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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