Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 63014 | CA |
NPI | 1073702155 |
---|---|
Provider Name | Dr. Bradley Milde |
First Address | San Luis Obispo, CA 93401-3145 |
Second Address | San Luis Obispo, CA 93401-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 10/10/2013 |