Provider Demographics
NPI:1942282231
Name:SWINGDORF, BRADLEY DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DUANE
Last Name:SWINGDORF
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 1:8329 DELANEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1308
Mailing Address - Country:US
Mailing Address - Phone:651-451-3278
Mailing Address - Fax:
Practice Address - Street 1:6105 CAHILL AVENUE EAST
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1308
Practice Address - Country:US
Practice Address - Phone:651-451-9101
Practice Address - Fax:651-451-9887
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN942018500OtherMEDICAL ASSISTANCE