Provider Demographics
NPI:1265906127
Name:BRAD PODRAY ORTHODONTICS LLC
Entity type:Organization
Organization Name:BRAD PODRAY ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PODRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-699-2580
Mailing Address - Street 1:201 S ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-3116
Mailing Address - Country:US
Mailing Address - Phone:515-964-5602
Mailing Address - Fax:
Practice Address - Street 1:201 S ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-3116
Practice Address - Country:US
Practice Address - Phone:515-964-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty