Provider Demographics
NPI:1609929264
Name:MILLER, J. BRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:BRAD
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:BRADLEY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA79931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice