Provider Demographics
NPI:1447447586
Name:STRUBLE, JOHN BRADFORD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADFORD
Last Name:STRUBLE
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 1:209 CANYON CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3203
Mailing Address - Country:US
Mailing Address - Phone:817-441-1211
Mailing Address - Fax:817-441-1202
Practice Address - Street 1:209 CANYON CT
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3203
Practice Address - Country:US
Practice Address - Phone:817-441-1211
Practice Address - Fax:817-441-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice