Organization
BULLDOG ADVENTURES, PLLC
Active
Other names
Madison Lake Family Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON J KELLY D.D.S. (OWNER)
(507) 382-0642
Entity
Organization
Contact information
Practice address
516 MAIN ST, MADISON LAKE, MN 56063-2027
(507) 243-3747
Mailing address
516 MAIN ST, MADISON LAKE, MN 56063-2027
(507) 243-3747
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12709
MN
Other
Enumeration date
01/13/2015
Last updated
01/13/2015
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