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General NPI Number Information
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NPI Number | 1871802223
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Entity Type | Individual
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Provider Name | BRAD PODRAY DMD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 456 SCHOOL LN SUITE 101
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City | HARLEYSVILLE
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State | PA
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Zip | 19438-1715
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Country | US
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Telephone | 215-513-1551
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Fax | 215-513-4255
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Provider Business Mailing Address
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Address Line | 401 COMMERCE DR SUITE 108
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-2714
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Country | US
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Telephone | 267-460-4254
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Fax | 215-646-6166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS038092
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License Number State | PA
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