Provider Demographics
NPI:1265651038
Name:AYDT, PATRICK ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:AYDT
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 1:13551 BALSAM L
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327
Mailing Address - Country:US
Mailing Address - Phone:763-422-1714
Mailing Address - Fax:763-712-5754
Practice Address - Street 1:13551 BALSAM L
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327
Practice Address - Country:US
Practice Address - Phone:763-422-1714
Practice Address - Fax:763-712-5754
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist