Provider Demographics
NPI:1124029913
Name:PODRATZ, ADAM WADE (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:WADE
Last Name:PODRATZ
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 1:627 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2423
Mailing Address - Country:US
Mailing Address - Phone:612-860-1365
Mailing Address - Fax:
Practice Address - Street 1:5201 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1819
Practice Address - Country:US
Practice Address - Phone:612-721-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5409-015122300000X
MND11569122300000X
CO8816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist