Bulldog Adventures, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12709 Issued in MN

Legal business name

BULLDOG ADVENTURES, PLLC

Doing business as

Madison Lake Family Dental Care

Practice address

516 Main St
Madison Lake, MN 56063-2027

Phone

(507) 243-3747

NPI assigned

Jan 13, 2015

Last updated

Jan 13, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brandon J Kelly, D.D.S.

Title

Owner

Phone

(507) 382-0642

Specialties & licenses 1

Addresses

Other names 1

• Madison Lake Family Dental Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1235528233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 MAIN ST",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "560632027",
            "telephone_number": "507-243-3747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MAIN ST",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "560632027",
            "telephone_number": "507-243-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLDOG ADVENTURES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-382-0642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Lake Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Donald Ackerman, PHARMACIST
• Alyssa Baker, LICSW
• Bryan D. Johnson, DDS, PA
• Christina Simonette DDS, PLLC
• Kristine Fasnacht Fumia, LAC
• Jennifer Alexandria Gerfen, CPM, LM
• Grace Margaret Hermer, OTR/L
• Kimberly Kopischke

• General Practice Dentistry in Madison Lake, MN
• Providers in Madison Lake, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.