Bradly Donabauer, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11563 Issued in MN

Practice address

310 S Broadway
Crookston, MN 56716-1913

Phone

(218) 281-1301

NPI assigned

Sep 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720179302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S BROADWAY",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161913",
            "telephone_number": "218-281-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S BROADWAY",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161913",
            "telephone_number": "218-281-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONABAUER",
        "first_name": "BRADLY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisaveta Ivanana Delorme
• Janet Marie Denison, LICSW, LADC
• Dental Health Center
• Jennifer Marie Derosier, LADC
• Vernon Desjarlais
• Ronald C Dorman, MD
• Janelle Lynn Doyle, LICSW
• Dr. Jaclyn M. Jensen DDS, PC
• Anthony Duncan, DO
• Brooke Elde

• General Practice Dentistry in Crookston, MN
• Providers in Crookston, 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 Jul 8, 2007; 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.