Provider Demographics
NPI:1598072142
Name:KEGLER, BRADLEY GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GEORGE
Last Name:KEGLER
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 1:206 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-1950
Mailing Address - Country:US
Mailing Address - Phone:319-334-3342
Mailing Address - Fax:319-334-6811
Practice Address - Street 1:206 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-1950
Practice Address - Country:US
Practice Address - Phone:319-334-3342
Practice Address - Fax:319-334-6811
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice