Healthcare Provider Details

I. General information

NPI: 1144373499
Provider Name (Legal Business Name): BRANDON E BUSSLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E. WILSON STREET
NORWOOD MN
55368-0717
US

IV. Provider business mailing address

2995 VILLAGE LANE
CHANHASSEN MN
55317
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-3518
  • Fax: 952-467-3528
Mailing address:
  • Phone: 952-470-0796
  • Fax: 952-467-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12253
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: