Provider Demographics
NPI:1295923423
Name:CATALDO, BRENT ALAN
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:CATALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 6TH AVE N
Mailing Address - Street 2:STE 102 B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6535
Mailing Address - Country:US
Mailing Address - Phone:763-544-7856
Mailing Address - Fax:763-544-8056
Practice Address - Street 1:10100 6TH AVE N
Practice Address - Street 2:STE 102 B
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6535
Practice Address - Country:US
Practice Address - Phone:763-544-7856
Practice Address - Fax:763-544-8056
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151252800Medicaid