Provider Demographics
NPI:1558452953
Name:DODDS, DUAINE BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUAINE
Middle Name:BRADLEY
Last Name:DODDS
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 1:7770 DELL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317
Mailing Address - Country:US
Mailing Address - Phone:952-944-3411
Mailing Address - Fax:952-914-0571
Practice Address - Street 1:7770 DELL ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHANHASEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-944-3411
Practice Address - Fax:952-914-0571
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9723200000OtherMEDICAL ASSISTANCE
MN45131DOOtherMEDICAL ASSISTANCE