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1679622039 NPI number — BRAD DOUGLAS BEKKEDAHL DDS

NPI Number: 1679622039
Health Care Provider/Practitioner: BRAD DOUGLAS BEKKEDAHL DDS

Information about “1679622039” NPI (BRAD DOUGLAS BEKKEDAHL DDS) exists in 1679622039 in HTML format HTML  |  1679622039 in plain Text format TXT  |  1679622039 in PDF (Portable Document Format) PDF  |  1679622039 in an XML format XML  formats.

NPI Number : 1679622039 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679622039",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEKKEDAHL",
    "FirstName": "BRAD",
    "MiddleName": "DOUGLAS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2204 2ND AVE W",
    "SecondLineMailingAddress": "SUITE 102",
    "MailingAddressCityName": "WILLISTON",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58801-3485",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "701-774-3333",
    "MailingAddressFaxNumber": "701-572-8504",
    "FirstLinePracticeLocationAddress": "2204 2ND AVE W",
    "SecondLinePracticeLocationAddress": "SUITE 102",
    "PracticeLocationAddressCityName": "WILLISTON",
    "PracticeLocationAddressStateName": "ND",
    "PracticeLocationAddressPostalCode": "58801-3485",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "701-774-3333",
    "PracticeLocationAddressFaxNumber": "701-572-8504",
    "EnumerationDate": "01/08/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "1726",
        "LicenseNumberStateCode": "ND",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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