Individual
BRADLEY JAMES MCDONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
895 7TH ST E, SAINT PAUL, MN 55106-3871
(651) 772-9757
(651) 772-9959
Mailing address
478 ROBERT STREET, ST. PAUL, MN 55107
(651) 602-7519
(651) 602-7518
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8707
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
413718300
MEDICAL ASST PROVIDER #
MN
Enumeration date
04/07/2006
Last updated
11/15/2016
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