Provider Demographics
NPI:1275787426
Name:J. BRADLEY MILLER DDS
Entity Type:Organization
Organization Name:J. BRADLEY MILLER DDS
Other - Org Name:IOWA FALLS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-648-4293
Mailing Address - Street 1:701 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-2100
Mailing Address - Country:US
Mailing Address - Phone:641-648-4293
Mailing Address - Fax:641-648-3784
Practice Address - Street 1:701 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2100
Practice Address - Country:US
Practice Address - Phone:641-648-4293
Practice Address - Fax:641-648-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079931223G0001X
IA059711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty