Provider Demographics
NPI:1407947278
Name:D. BRADLEY DODDS, D.D.S., P.A.
Entity Type:Organization
Organization Name:D. BRADLEY DODDS, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DUAINE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-944-3411
Mailing Address - Street 1:7770 DELL ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9320
Mailing Address - Country:US
Mailing Address - Phone:952-944-3411
Mailing Address - Fax:952-914-0571
Practice Address - Street 1:7770 DELL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-944-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty