Individual
DR. BRADLEY LEE VIDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
140 BIRCH ST N STE 106, CAMBRIDGE, MN 55008-1547
(763) 689-3134
Mailing address
140 BIRCH ST. N STE. # 106, CAMBRIDGE, MN 55008
(763) 689-3134
(763) 689-6609
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8936
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-4079726
MEDICAL ASSISTANCE
MN
Enumeration date
02/22/2008
Last updated
01/06/2012
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