Provider Demographics
NPI:1215934369
Name:BRUCHMILLER, BRADLEY DALE (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DALE
Last Name:BRUCHMILLER
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 1:14855 BLANCO RD
Mailing Address - Street 2:STE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7728
Mailing Address - Country:US
Mailing Address - Phone:210-493-6067
Mailing Address - Fax:210-493-0430
Practice Address - Street 1:14855 BLANCO RD
Practice Address - Street 2:STE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7728
Practice Address - Country:US
Practice Address - Phone:210-493-6067
Practice Address - Fax:210-493-0430
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics