Healthcare Provider Details

I. General information

NPI: 1265651038
Provider Name (Legal Business Name): PATRICK ANTHONY AYDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13551 BALSAM L
DAYTON MN
55327
US

IV. Provider business mailing address

13551 BALSAM L
DAYTON MN
55327
US

V. Phone/Fax

Practice location:
  • Phone: 763-422-1714
  • Fax: 763-712-5754
Mailing address:
  • Phone: 763-422-1714
  • Fax: 763-712-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10574
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: