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General NPI Number Information
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NPI Number | 1407947278
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Entity Type | Organization
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Legal Business Name | D. BRADLEY DODDS, D.D.S., P.A.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 7770 DELL RD SUITE 160
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City | CHANHASSEN
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State | MN
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Zip | 55317
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Country | US
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Telephone | 952-944-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 7770 DELL ROAD SUITE 160
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City | CHANHASSEN
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State | MN
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Zip | 55317-9320
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Country | US
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Telephone | 952-944-3411
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Fax | 952-914-0571
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Authorized Official
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Title or Position | DENTIST
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Name | DUAINE BRADLEY DODDS
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Credential | DDS
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Telephone | 952-944-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9017
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License Number State | MN
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