Provider Demographics
NPI:1043329642
Name:PUGH, BRADFORD J (DDS)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:J
Last Name:PUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:DEERWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56444-0385
Mailing Address - Country:US
Mailing Address - Phone:218-534-3141
Mailing Address - Fax:218-534-3949
Practice Address - Street 1:21343 ARCHIBALD RD
Practice Address - Street 2:
Practice Address - City:DEERWOOD
Practice Address - State:MN
Practice Address - Zip Code:56444
Practice Address - Country:US
Practice Address - Phone:218-534-3141
Practice Address - Fax:218-534-3949
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice