Provider Demographics
NPI:1508924804
Name:IGNEY, BRADLEY S (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:IGNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1548
Mailing Address - Country:US
Mailing Address - Phone:260-665-7517
Mailing Address - Fax:
Practice Address - Street 1:224 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1548
Practice Address - Country:US
Practice Address - Phone:260-665-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice