Bradly Donabauer, DDS
Individual provider Active NPI General Practice Dentistry · Crookston, MN
NPI 1720179302 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720179302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 11563 (MN)
- Practice address
- 310 S Broadway
Crookston, MN 56716-1913 - Phone
- (218) 281-1301
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11563 | MN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11563 | MN | Yes |
Addresses
Primary practice location
310 S Broadway
Crookston, MN 56716-1913
Mailing address
310 S Broadway
Crookston, MN 56716-1913
Phone (218) 281-1301
Other providers in Crookston, MN
- Elisaveta Ivanana Delorme
- Janet Marie Denison
- Dental Health Center
- Jennifer Marie Derosier
- Vernon Desjarlais
- Ronald C Dorman
- Janelle Lynn Doyle
- Dr. Jaclyn M. Jensen DDS, PC
- Anthony Duncan
- Brooke Elde
All providers in Crookston, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.