Provider Demographics
NPI:1326023532
Name:BRANDJORD, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BRANDJORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 E NICOLLET BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6734
Mailing Address - Country:US
Mailing Address - Phone:952-435-0310
Mailing Address - Fax:952-435-0311
Practice Address - Street 1:625 E NICOLLET BLVD
Practice Address - Street 2:STE 205
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6734
Practice Address - Country:US
Practice Address - Phone:952-435-0310
Practice Address - Fax:952-435-0311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN7526204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44B04BROtherBCBS
86000126OtherMEDICA
T39336Medicare UPIN