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General NPI Number Information
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NPI Number | 1508925017
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Entity Type | Organization
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Legal Business Name | BRENT CATALDO DDS PA
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 1025 EVERGREEN LN N
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City | PLYMOUTH
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State | MN
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Zip | 55441-4800
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Country | US
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Telephone | 763-544-7856
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Fax |
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Provider Business Mailing Address
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Address Line | 7375 INLAND LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-3958
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Country | US
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Telephone | 763-420-1335
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRENT ALAN CATALDO
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Credential | DDS
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Telephone | 763-420-1335
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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 | D11411
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License Number State | MN
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