Active NPI
Bradley Lee Videen, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Cambridge, MN
National Provider Identifier
1407025521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 8936
- Practice address
- 140 Birch St N Ste 106
Cambridge, MN 55008-1547 - Phone
- (763) 689-3134
- NPI assigned
- Feb 22, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 8936 | MN | Primary |
Addresses
Primary practice location
140 Birch St N Ste 106
Cambridge, MN 55008-1547
Mailing address
140 Birch St. N Ste. # 106
Cambridge, MN 55008
Phone (763) 689-3134
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45-4079726 | Other | MN | MEDICAL ASSISTANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cambridge Orthodontics PA | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Cambridge, MN
- NPI 1124244603
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1407025521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 BIRCH ST. N STE. # 106",
"city": "CAMBRIDGE",
"state": "MN",
"postal_code": "55008",
"telephone_number": "763-689-3134",
"fax_number": "763-689-6609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 BIRCH ST N STE 106",
"city": "CAMBRIDGE",
"state": "MN",
"postal_code": "550081547",
"telephone_number": "763-689-3134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDEEN",
"first_name": "BRADLEY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-22",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MN",
"license": "8936",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "45-4079726",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.