Provider Demographics
NPI:1508925017
Name:BRENT CATALDO DDS PA
Entity Type:Organization
Organization Name:BRENT CATALDO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CATALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-420-1335
Mailing Address - Street 1:7375 INLAND LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3958
Mailing Address - Country:US
Mailing Address - Phone:763-420-1335
Mailing Address - Fax:
Practice Address - Street 1:1025 EVERGREEN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4800
Practice Address - Country:US
Practice Address - Phone:763-544-7856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty