Individual
DR. BRADLEY LEE VIDEEN
Active
Individual
DR. BRADLEY LEE VIDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
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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