Provider Demographics
NPI:1114122397
Name:NORDEN, BRAD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JOHN
Last Name:NORDEN
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 1:1710 E MADISON AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2189
Mailing Address - Country:US
Mailing Address - Phone:847-393-3466
Mailing Address - Fax:
Practice Address - Street 1:1710 E MADISON AVE
Practice Address - Street 2:STE 600
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2189
Practice Address - Country:US
Practice Address - Phone:847-393-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice